Remote Healthcare Claims Specialist

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

Benefits offered by this job

On-site training

Remote work after training

Job summary

Health Care Service Corporation in Albuquerque, NM is seeking a Claims Technician to process and adjudicate healthcare claims, investigate discrepancies, and coordinate benefits under HIPAA. The role starts with mandatory on-site training (8am–5pm).

After successful completion, remote work from home options are available, with ongoing support and performance coaching. Ideal candidates have a high school diploma or GED, strong data entry, MS Office, and experience handling high-volume claims with

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 high-volume workloads while maintaining quality metrics.
• Strong attention to detail, problem-solving, and organizational skills.

Responsibilities

• Process complex claims in various queues.
• Resolve complex pended claims, duplicate claims and adjustments.
• Process claims, involving communications with participating plans and/or Service Units.
• Research and identify other insurance, Medicare, Medicaid and update patient file as needed.
• Coordinate benefits; request explanation of benefits as needed.
• Maintain knowledge related to CPT, HCPCS, and ICD9 coding.
• 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.

Skills

Data entry

MS Office

Typing

Communication

Claims processing

Education

High School diploma or GED

Tools

Blue Chip

Job description

Health Care Service Corporation in Albuquerque, NM is seeking a Claims Technician to process and adjudicate healthcare claims, investigate discrepancies, and coordinate benefits under HIPAA. The role starts with mandatory on-site training (8am–5pm).

After successful completion, remote work from home options are available, with ongoing support and performance coaching. Ideal candidates have a high school diploma or GED, strong data entry, MS Office, and experience handling high-volume claims with