Health Claims Specialists

Sutherland; United States; Remote; USD 15,000 - 22,000; Full time

Benefits offered by this job

Bonus potential

Health plan

Paid training

Paid PTO

Company equipment

Career advancement

Rewards program

Employee discounts

EAP & Wellness

Weekday schedule

Job summary

Sutherland is seeking a Claims Examiner to process claims via data entry predominantly and adjudicate claims with attention to policy, procedure, and regulatory guidelines.

You will follow up on incomplete claims, refer complex items for review, and ensure information privacy. The role involves working with our software and may include special projects and team training sessions.

Qualifications

• High School Diploma or equivalent.
• Excellent Internet connectivity: 2 Mbps upload and 10 Mbps download — the faster the better.
• House network and a hard-wired internet connection capable of consistently supporting call quality.
• A quiet, distraction-free, secure place to work.
• Effective verbal and written communication skills.
• Strong typing and analytical abilities.
• Minimum 40 words per minute on typing test.
• Must have and maintain a clean, paper-free work environment to meet policies.
• Medical Billing and Coding degree/certification.
• Experience in a medical office setting with knowledge of insurance, claims, billing or coding.

Responsibilities

• Work independently, processing claims via data entry for 90% of your day.
• Adjudicate claims to meet production, quality, and other metrics per policy and guidelines.
• Follow up on claims needing additional information.
• Refer problem claims to a Lead and/or auditor for review.
• Maintain information privacy per HIPAA guidelines.
• Work with specific software used by the team.
• 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

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.

Qualifications:

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 notcompatible 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