Remote Healthcare Claims Technician

Health Care Service Corp.; Albuquerque (NM); On-site; USD 24,000 - 36,000; Full time

Job summary

Health Care Service Corporation in Albuquerque, NM is seeking a Claims Technician responsible for processing complex healthcare claims, coordinating benefits, and resolving denials. You will review, adjudicate, and ensure accurate service in line with policies and regulations, including HIPAA compliance.

The role starts at $17.75 per hour with mandatory onsite training (Mon-Fri, 8am-5pm). After training, a work-from-home arrangement is considered based on performance.

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, phone providers as necessary, access materials to process and adjudicate timely.
• 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 of medical terminology and CPT, HCPCS, and ICD9 coding.
• Learn and maintain knowledge of DOL ERISA and prompt pay legislation.

Skills

Attention to detail

Analytical skills

Clear communication

High-volume workloads

Problem-solving

Education

High School diploma or GED

Tools

Microsoft Office

Excel

IMAGE system

Financial Suspense System (FSS)

Job description

Health Care Service Corporation in Albuquerque, NM is seeking a Claims Technician responsible for processing complex healthcare claims, coordinating benefits, and resolving denials. You will review, adjudicate, and ensure accurate service in line with policies and regulations, including HIPAA compliance.

The role starts at $17.75 per hour with mandatory onsite training (Mon-Fri, 8am-5pm). After training, a work-from-home arrangement is considered based on performance.