Health Claims Specialists

Sutherland; Kentucky; On-site; USD 27,000 - 30,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

Paid training and PTO

Company-provided equipment

Advancement opportunities

Monthly rewards & recognition programs

Employee discounts

Health and Wellness programs

Job summary

Sutherland is hiring a full-time permanent healthcare claims adjudicator. You will process medical claims via data entry, adjudicate to policy and regulatory guidelines, and maintain privacy according to HIPAA.

The role emphasizes independence with support from knowledge base and team, with KPI-driven performance during training and beyond. You will handle various claims, follow up on exceptions, and may be assigned special projects.

Qualifications

• High School Diploma or equivalent.
• Medical Billing and Coding degree/certification.
• Previous experience in a medical office setting, including some knowledge of insurance, claims, billing or coding.
• Knowledge of Medical terminology.

Responsibilities

• Process claims via data entry for 90% of the day.
• Adjudicate claims to meet production, quality and other metrics.
• Follow up on claims needing additional information.
• Refer problem claims to Lead/auditor for review.
• Maintain information privacy per HIPAA guidelines.
• Work with specific software.
• May be assigned special projects.

Skills

Data entry

Time management

Attention to detail

Analytical

Education

High School Diploma or equivalent

Medical Billing and Coding degree/certification

Job description

This is a full-time permanent healthcare claims adjudicator position. A claims adjudicator determines how much money will be paid after an insurance claim has been examined. This is not a customer service or customer facing position. This is a data entry position where you will be processing medical claims per the specific client requirements. Claims can vary and are highly customized depending on the service level. You will work independently with the assistance of knowledge base and support personnel. You will also be expected to meet all Key Performance Indicators and Quality goals throughout Training and beyond.

What you will be doing as a Claims Examiner:

• Work independently, processing claims via data entry for 90% of your day.
• Be responsible for effectively adjudicating claims to meet production, quality, and other metrics in accordance with policy/procedures and regulatory guidelines
• Follow up on claims needing additionalinformation
• Refer problem claims to a Lead and/or auditor for additional review
• Make sure that the integrity of the information is accurate and kept private according to HIPPA guidelines
• Work with specific software
• May be assigned special projects

When you join us, you’ll enjoy:

• Pay rate of $13.50/hour with the opportunity to bonus an additional $1500 a month.
• Medical, dental, and vision plans.
• Paid training and PTO (be sure to ask about our Global Flexible Vacation Policy).
• Company-provided equipment.
• Advancement opportunities - 80% of our frontline leaders have been promoted from within.
• Monthly rewards & recognition programs.
• Employee Discounts.
• EAP and Health and Wellness programs including a personal trainer dedicated to Sutherland.
• Weekday schedule, Monday - Friday 8:30 AM - 5:00 PM EST.

Skills

• Data entry
• Time management
• Attention to detail
• Analytical

Required Qualifications

• High School Diploma or equivalent
• Excellent Internet Connectivity:
  • Internet access speed of 2 Mbps upload and 10 Mbps download - the faster the better.
  • house network, and a hard-wired internet connection capable of continuously supporting outstanding call quality and high-speed response rates. (Wireless and/or satellite Internet Service Providers are not compatible with our systems)
• A quiet and distraction-free, secure place to work
• Effective verbal and written communication skills
• Strong typing and analytical abilities
• Multi-tasking skills with a strong attention to detail
• Computer knowledge
• Minimum 40 words per minute on typing test
• Must have and maintain a clean and paper free work environment to meet our company policies.
• Medical Billing and Coding degree/certification.
• Previous experience in a medical office type setting, including some knowledge of insurance, claims, billing or coding, with an understanding of the different types of insurance (Medicare/Medicaid and/or Child Plus).
• Knowledge of Medical terminology

All your information will be kept confidential according to EEO guidelines.

EEOC and Veteran Documentation

During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.
At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.