Remote Healthcare Claims Processing Specialist

TechDigital Group; Iowa (LA); On-site; USD 55,000 - 75,000; Full time

Job summary

TechDigital Group seeks a Claims Processing Executive to join our healthcare team. The role leverages MS Excel to manage and process commercial claims, with a remote, day-shift schedule that fits work-life balance.

You will review, validate, and adjudicate claims, verify eligibility under Medicare/Medicaid/commercial plans, and ensure HIPAA compliance. Proficiency with QNXT is required, along with strong analytical and communication skills.

Qualifications

• High school diploma or equivalent required.
• 2–4 years of US healthcare claims processing experience.
• Knowledge of Medicare/Medicaid and commercial payers.
• Experience with QNXT or similar claims platform preferred.

Responsibilities

• Review, validate, and process healthcare claims per payer guidelines.
• Utilize core platform QNXT for claims processing (required).
• Verify patient eligibility, benefits, and pre-authorizations.
• Adjudicate: approve, deny, or adjust claims per guidelines.
• Maintain HIPAA compliance and CMS guidelines.
• Document activity, maintain audit trails, and prepare reports.

Skills

US healthcare claims processing

Healthcare insurance systems knowledge

Analytical skills

Communication skills

Policy interpretation

Attention to detail

Problem solving

Education

High school diploma or equivalent

Tools

EDI transactions

Job description

TechDigital Group seeks a Claims Processing Executive to join our healthcare team. The role leverages MS Excel to manage and process commercial claims, with a remote, day-shift schedule that fits work-life balance.

You will review, validate, and adjudicate claims, verify eligibility under Medicare/Medicaid/commercial plans, and ensure HIPAA compliance. Proficiency with QNXT is required, along with strong analytical and communication skills.