Claims Processor - Work from Home

Sagility Member Enrollment LLC; United States; Remote; USD 19,000 - 28,000; Full time

Benefits offered by this job

Medical, Dental, and Vision

401(k) with employer contribution

PTO

Tuition Reimbursement

Life Insurance

Disability (Short/Long)

FSA

EAP

Paid Time Off

Background checks

Job summary

BroadPath, a Sagility Company, is hiring experienced medical Claims Processors to join our remote team. You will review and process medical claims from start to finish, ensuring accuracy and compliance with CMS guidelines.

Claims will be reviewed across multiple platforms, with pay and schedule details determined by client needs. We offer a remote, work-from-home role with weekly pay and benefits including medical, dental, vision, life insurance, disability, FSA, 401(k), PTO, and tuition

Qualifications

• Minimum of one year of recent experience processing medical claims for a health insurance company or payer.
• Familiarity with CMS-1500 and UB-04 forms.
• Working knowledge of ICD-10, HCPCS, and CPT coding systems.
• Proficient with Windows OS and Excel.
• Excellent verbal and written communication skills.
• Ability to stay focused in a high-volume, repetitive environment.

Responsibilities

• Review medical claims thoroughly to ensure information is complete.
• Navigate systems to research and process claims accurately.
• Apply benefits per policy, including CMS guidelines and state mandates.
• Assess whether a visit is necessary and covered.
• Determine pay/deny outcomes and issue denial letters when applicable.

Skills

Medical claims processing

CMS-1500 & UB-04 familiarity

ICD-10, HCPCS, CPT knowledge

Microsoft Windows

Excel (advanced)

Strong communication

High-volume/repetitive work

High School Diploma or equivalent

Education

High School Diploma or equivalent

Tools

Microsoft Windows

Excel

Job description

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title: Claims Processor - Work from Home

Job Description: BroadPath, a Sagility Company, is hiring experienced medical Claims Processors to join our remote team! Claims Processors are responsible for the accurate and timely entry, review, and resolution of medical claims ranging from simple to moderately complex. This includes reviewing front-end claims and validating information submitted by patients or providers seeking reimbursement from the insurance company. All claim processing must align with CMS guidelines and client-specific policies and procedures. Schedules, pay rates, and program details may vary based on business needs and client assignment.

Compensation Highlights

• Base Pay: Starting at $17 per hour Pay frequency: Weekly pay Schedule Highlights Schedules can fall between the hours of Monday-Friday, 8:00 AM - 10:00 PM Eastern Time, and will be assigned based on business needs.

Responsibilities

• Review medical claims thoroughly to ensure no missing or incomplete information.
• Navigate multiple computer systems and platforms to research and process assigned claims accurately (e.g., verifying pricing, prior authorizations).
• Apply appropriate benefits to each claim in accordance with claims processing policies, including grievance procedures, state mandates, CMS guidelines, and benefit plan documents.
• Review documentation to assess whether the visit was necessary and whether the policy covers the treatment received.
• Determine if claims should be paid or denied, and complete denial letters when applicable.

Qualifications

• Minimum of one year of recent experience processing medical claims for a health insurance company or payer.
• Familiarity with medical claim forms (CMS-1500 and UB-04).
• Working knowledge of coding systems: ICD-10, HCPCS, and CPT.
• Proficient in computer navigation and technology, including Microsoft Windows, Excel (advanced functions), and web-based tools and platforms.
• Excellent verbal and written communication skills.
• Ability to remain focused and productive in a high-volume, repetitive task environment.
• High School Diploma or equivalent.

At BroadPath, a Sagility Company, we believe that transparency, authenticity, and collaboration are the keys to building strong, connected remote teams. Being on camera is an integral part of our culture. It is how we build relationships, share ideas, and stay engaged. If you are someone who values open communication, connection, and teamwork, you will thrive in our environment where showing up authentically matters.

What to Expect

• On-camera participation during interviews, training, team meetings, and regular check-ins.
• Face-to-face discussions sparking collaboration and engagement.
• A supportive atmosphere where you can express yourself openly and be part of a team that values your contributions.

Benefits

• Medical, Dental, and Vision coverage.
• Life Insurance.
• Short-Term and Long-Term Disability options.
• Flexible Spending Account (FSA).
• Employee Assistance Program.
• 401(k) with employer contribution.
• Paid Time Off (PTO).
• Tuition Reimbursement.

BroadPath, a Sagility Company, may conduct background checks, previous employment verifications, and education verifications, based on position requirements.

Diversity Statement

At BroadPath, a Sagility Company, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!

Equal Employment Opportunity/Disability/Veterans

If you need accommodation due to a disability, please email us at [e-mail]. This information will be held in confidence and used only to determine an appropriate accommodation for the application process BroadPath, a Sagility Company is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law.

Compensation

Compensation:BroadPath a Sagility Company has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Location

Work@Home USAUnited States of America

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.