Remote Medical Claims Specialist I

your Jared; Northern (KY); Hybrid; USD 36,000 - 48,000; Full time

Job summary

PEHP Health & Benefits, a division of the Utah Retirement Systems, seeks an attentive claims processor to support medical and Medicare claims processing with accuracy and efficiency.

The role requires reviewing claims, verifying eligibility, and applying policy guidelines while maintaining confidentiality and meeting deadlines. A high school diploma and at least one year of related experience are preferred, with remote work available for most days.

Qualifications

• High School diploma required; one year of work experience preferred in claims processing or related admin work.
• Must possess strong attention to detail and accuracy when reviewing claims and patient data.
• Strong communication skills, both verbal and written, for member and team interactions.

Responsibilities

• Receives and enters medical and/or Medicare claims for payment under medical and/or Medicare Supplement plans.
• Reviews claims for accuracy and completeness, verifies coverage and eligibility of patient.
• Adjudicates routine and complex claims according to established policy guidelines.
• Processes coordination of benefits on Medical and Dental claims.
• Maintains regular and reliable attendance.
• Maintains strict confidentiality.
• Performs other related duties as required.

Skills

Claims processing

Attention to detail

Communication

Teamwork

Multitasking

Education

High School diploma

Job description

PEHP Health & Benefits, a division of the Utah Retirement Systems, seeks an attentive claims processor to support medical and Medicare claims processing with accuracy and efficiency.

The role requires reviewing claims, verifying eligibility, and applying policy guidelines while maintaining confidentiality and meeting deadlines. A high school diploma and at least one year of related experience are preferred, with remote work available for most days.