Remote Claims Research & Resolution Specialist

Jobgether SRL; United States; Remote; USD 43,000 - 56,000; Full time

Job summary

Jobgether SRL is partnering to fill a Claims Research Resolution Rep role in the United States. You will resolve complex healthcare claims, review supporting docs, and apply policies to determine resolutions. The position emphasizes accuracy, privacy, and timely outcomes while collaborating with providers, members, and internal teams.

The role offers a remote work setup within the U.S. and includes a structured eight-week training program, with expectations to remain in role for 18 months and

Qualifications

• At least one year of healthcare customer service experience.
• At least one year of call center experience.
• Intermediate proficiency in Microsoft Excel.
• Intermediate proficiency in Microsoft Word.
• Working knowledge of healthcare terminology and medical claims processes.
• Familiarity with Medicare or Medicaid claims.

Responsibilities

• Investigate, research, and resolve complex medical claims issues with providers, members, and third-party services to achieve accurate outcomes.
• Review claims discrepancies, validate documentation, and apply policies and regulatory requirements.
• Collaborate with claims specialists and internal stakeholders to investigate pending claims and address issues.
• Respond to inquiries through multiple channels, adapting to workload and priorities.
• Maintain records of investigations and decisions with strict data privacy.

Skills

Healthcare terminology

Customer service

Call center

Excel

Word

Analytical skills

Communication

Privacy/compliance

Job description

Jobgether SRL is partnering to fill a Claims Research Resolution Rep role in the United States. You will resolve complex healthcare claims, review supporting docs, and apply policies to determine resolutions. The position emphasizes accuracy, privacy, and timely outcomes while collaborating with providers, members, and internal teams.

The role offers a remote work setup within the U.S. and includes a structured eight-week training program, with expectations to remain in role for 18 months and