Remote Healthcare Claims Specialist

Health Care Service Corporation; Albuquerque (NM); Hybrid; USD 25,000 - 37,000; Full time

Job summary

Health Care Service Corporation in Albuquerque is seeking a Claims Technician to process complex healthcare claims under supervision, including coordination of benefits and resolving pended items. The role emphasizes accuracy, productivity, and compliant handling of HIPAA requirements.

Starting pay falls between: $17.75 to $18.25, with a mandatory six-week onsite training (Mon-Fri, 8am-5pm). After successful completion of training, a work-from-home arrangement is established, with compensation

Qualifications

• High School diploma or GED is required.
• 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 and adjudicate timely.
• Resolve complex pended claims, duplicates, and adjustments.
• Communicate with participating plans and service units to resolve issues.
• Research other insurances (Medicare/Medicaid) and update patient files.
• Coordinate benefits and request explanations of benefits when needed.
• Maintain knowledge of medical terminology and CPT/HCPCS/ICD9 coding.
• Read files in IMAGE and apply data to claims using FSS.
• Learn ERISA and prompt pay regulations.
• Overtime may be required based on business needs.

Skills

Data entry

Typing

MS Office (Excel)

Written & verbal communication

Claims processing experience

Attention to detail

Analytical skills

Organizational skills

Education

High School diploma or GED

Tools

Blue Chip system

IMAGE

FSS (Financial Suspense System)

Microsoft Office Suite (Excel)

Job description

Health Care Service Corporation in Albuquerque is seeking a Claims Technician to process complex healthcare claims under supervision, including coordination of benefits and resolving pended items. The role emphasizes accuracy, productivity, and compliant handling of HIPAA requirements.

Starting pay falls between: $17.75 to $18.25, with a mandatory six-week onsite training (Mon-Fri, 8am-5pm). After successful completion of training, a work-from-home arrangement is established, with compensation