Remote Insurance Claims Follow-Up & Appeals Specialist

Insight Global; Maryland; Remote; USD 60,000 - 85,000; Full time

Job summary

Insight Global is seeking an Insurance Claim Follow Up Representative to support a large hospital system in the Maryland/DC area. Primary focus is on outpatient BCBS claims, resolving underpayments, denials, and contract interpretation issues.

You will review EOBs, identify discrepancies, and take corrective actions with payers, working fully remotely. The role requires handling outpatient claims, using BCBS portals, and ensuring accuracy in pricing per contract terms.

Qualifications

• 5+ years experience in claims follow-up & appeals handling.
• Experience with UB04 forms and understanding payer denial mechanisms.
• Experience interacting with BCBS CareFirst and/or BlueCard.
• Familiarity with payer portals and contract interpretation.
• Ability to process ~80 claims per day with high accuracy (98%).
• Knowledge of ICD and CPT codes and their application in billing.
• Strong attention to detail to spot errors in claims/contracts.
• Analytical thinking to identify pricing variances and under/overpayments.
• Proficient in Excel and collaboration tools; remote work experience.

Responsibilities

• Take ownership of outpatient hospital claims after billing, especially denied or underpaid ones.
• Determine payments, denials, and reasons for action.
• Identify and resolve technical denials related to coding, COBs, and contract interpretation.
• Handle outpatient claims for BCBS CareFirst and/or BlueCard; navigate contracts.
• Use payer portals to follow up and resolve issues; communicate with payers.
• Accurately price claims based on contract terms and identify variances.

Skills

Claims follow-up

UB04 forms

BCBS CareFirst

Payer portal

80 claims/day

ICD/CPT codes

Attention to detail

Analytical thinking

Excel

Teams

Tools

Med-Connect

RCI

Envision (SMS)

Epic

Job description

Insight Global is seeking an Insurance Claim Follow Up Representative to support a large hospital system in the Maryland/DC area. Primary focus is on outpatient BCBS claims, resolving underpayments, denials, and contract interpretation issues.

You will review EOBs, identify discrepancies, and take corrective actions with payers, working fully remotely. The role requires handling outpatient claims, using BCBS portals, and ensuring accuracy in pricing per contract terms.