Remote Insurance Claims Resolution Specialist

Sherloq Solutions, Inc.; United States; Remote; USD 25,000 - 30,000; Full time

Job summary

SHERLOQ Solutions in the United States is seeking a Healthcare Claims Specialist to bridge communications between healthcare providers and health insurance payers to expedite claim resolutions. Your responsibilities include resolving claims via verbal or online inquiries, navigating provider systems and payer websites, verifying patient and billing data, and analyzing denials to secure reimbursement.

This remote role demands excellent communication, detail orientation, and the ability to perform

Qualifications

• High school diploma required.
• 3 years healthcare industry experience required.
• 1 year healthcare claims billing/denials experience required.
• HFMA CRCR or AAHAM CRCS accreditation within two years.

Responsibilities

• Resolve healthcare claims through verbal or online inquiries to health insurance payers.
• Effectively navigate and utilize healthcare provider systems, billing platforms, and payer websites.
• Verify patient, insurance, billing and claim submission information for accuracy.
• Eligibility inquiries and COB research including reaching out to the patient when necessary.
• Analyze payer denials to secure claim reimbursement and support appeals as needed.
• Track trends in payer underpayments and report to leadership for escalation.

Skills

Communication skills

Negotiation skills

Attention to detail

Problem solving

Education

High school diploma

3 years healthcare industry experience

1 year healthcare claims billing/denials experience

HFMA CRCR accreditation within 2 years

AAHAM CRCS accreditation within 2 years

Tools

Microsoft 365

Job description

SHERLOQ Solutions in the United States is seeking a Healthcare Claims Specialist to bridge communications between healthcare providers and health insurance payers to expedite claim resolutions. Your responsibilities include resolving claims via verbal or online inquiries, navigating provider systems and payer websites, verifying patient and billing data, and analyzing denials to secure reimbursement.

This remote role demands excellent communication, detail orientation, and the ability to perform