Remote Claims Research & Resolution Specialist

Jobgether SRL; United States; À distance; USD 43 000 - 56 000; Plein temps

Avantages offerts par ce poste

Remote work

Healthcare coverage

401(k) retirement plan

Paid time off

Parental leave

Disability & life insurance

Structured onboarding

Professional development

Team collaboration

Well-being resources

Résumé du poste

Jobgether SRL is seeking a Healthcare Claims Support Specialist in the United States to investigate and resolve complex medical claims by working with providers, members, and third-party services. This role requires strong analytical skills, healthcare knowledge, and customer-focused communication.

You will review discrepancies, validate documentation, and apply policies to reach timely resolutions. A remote work setup is available with training and career development opportunities.

Qualifications

• At least one year of healthcare customer service experience.
• At least one year of call center experience.
• Intermediate proficiency in Microsoft Excel to organize, review, and analyze data.
• Intermediate proficiency in Microsoft Word for documentation and admin tasks.
• Working knowledge of healthcare terminology and medical claims processes.
• Familiarity with Medicare or Medicaid claims and related procedures.
• Strong analytical and problem-solving skills for discrepancies.
• Excellent verbal and written communication with a customer focus.
• Strong organizational skills and ability to manage competing priorities.
• Ability to work independently and adapt to changing workloads.
• Quiet, secure home workspace with reliable internet (25 Mbps down, 10 Mbps up).
• Ability to protect confidential member information and privacy requirements.

Responsabilités

• Investigate, research, and resolve complex medical claims issues with providers, members, and third-party services.
• Review claims discrepancies, validate documentation, and apply policies to determine resolutions.
• Collaborate with claims specialists, call center reps, provider associates, and other stakeholders.
• Respond to claims inquiries through various channels, adjusting to workload changes.
• Apply judgment to determine effective resolution strategies and handle admin tasks independently.
• Maintain accurate records of investigations and decisions while ensuring data security.
• Manage multiple assignments and shift between projects as workload changes.
• Participate in training, team meetings, and ongoing learning to stay proficient.

Connaissances

Healthcare terminology

Analytical skills

Customer service

Communication skills

Time management

Independence

Privacy & data security

Outils

Microsoft Excel

Microsoft Word

Microsoft Access

Description du poste

Jobgether SRL is seeking a Healthcare Claims Support Specialist in the United States to investigate and resolve complex medical claims by working with providers, members, and third-party services. This role requires strong analytical skills, healthcare knowledge, and customer-focused communication.

You will review discrepancies, validate documentation, and apply policies to reach timely resolutions. A remote work setup is available with training and career development opportunities.