Remote Claims Technician: Complex Healthcare Claims

HCSC Group; Albuquerque, Northern (NM, KY); Hybrid; USD 24,000 - 36,000; Full time

Benefits offered by this job

Health benefits

401(k) savings plan

Pension plan

Paid time off

Paid parental leave

Disability insurance

Supplemental life insurance

Employee assistance program

Paid holidays

Tuition reimbursement

Job summary

HCSC is seeking a Claims Technician to process complex healthcare claims, investigate discrepancies, and resolve pended claims with a focus on accuracy, productivity, and regulatory compliance. A mandatory six-week onsite training is provided, after which work-from-home provisions may be established.

Starting pay ranges from $17.75 to $18.25 per hour, with a broader base pay range later. The role requires strong data entry, Excel proficiency, and knowledge of HIPAA, CPT/HCPCS/ICD9 coding, and

Qualifications

• High School diploma or GED.
• Solid data entry and/or typing experience.
• Proficiency in Microsoft Office Suite, including Excel for data review and reporting.
• Clear and concise written and verbal communication skills.
• Experience processing medical claims with the ability to manage high-volume workloads while maintaining quality metrics.
• Strong attention to detail, problem-solving, and organizational skills.

Responsibilities

• Process complex claims in various queues.
• Conduct research and investigation into missing information, make phone calls to providers (as necessary), access resource materials and support files in order to process and adjudicate claims timely and accurately.
• Resolve complex pended claims, duplicate claims and adjustments.
• Process claims, involving communications with participating plans and/or Service Units.
• Resolve various issues.
• Research and identify other insurance, Medicare, Medicaid and update patient file as needed.
• Coordinate benefits; request explanation of benefits as needed.
• Maintain a working understanding of medical terminology and CPT, HCPCS, and ICD9 coding.
• Maintain knowledge related to specific contracts.
• Read appropriate files in IMAGE and apply information to claims as needed using the Financial Suspense System (FSS).
• Learn and maintain knowledge of DOL ERISA and prompt pay legislation.
• Periodic overtime may be required at the sole discretion of the employer based on business need.

Skills

Healthcare claims processing

Data entry

Communication

HIPAA knowledge

Attention to detail

Education

High School diploma

Tools

Microsoft Excel

Microsoft Office Suite

Job description

HCSC is seeking a Claims Technician to process complex healthcare claims, investigate discrepancies, and resolve pended claims with a focus on accuracy, productivity, and regulatory compliance. A mandatory six-week onsite training is provided, after which work-from-home provisions may be established.

Starting pay ranges from $17.75 to $18.25 per hour, with a broader base pay range later. The role requires strong data entry, Excel proficiency, and knowledge of HIPAA, CPT/HCPCS/ICD9 coding, and