Account Resolution Specialist - Insurance HMOs - Digitech - Remote

Essential Duties And Responsibilities

• Research and resolve outstanding insurance claims, including those that are pending, unable to be released, denied, or paid incorrectly by commercial insurance carriers
• Investigate claims placed on hold, identifying root causes, correcting errors, and executing needed follow-up actions to release claims for processing
• Analyze insurance denials, determining denial reasons, assessing validity, and completing the appropriate resolution steps such as appeals, corrections, or resubmission
• Communicate directly with insurance carriers via outbound calls to obtain claim status, clarify discrepancies, and secure detailed explanations for pending or denied claims
• Prepare and submit additional documentation requested by insurance carriers to support claim adjudication and ensure accurate processing
• Draft and submit appeals when necessary, ensuring they are supported by proper documentation, regulatory guidelines, and payer-specific requirements
• Process and manage incoming correspondence, including mail, emails, EOBs, requests for information, and any necessary refunds
• Maintain accurate, detailed notes in billing systems for all follow-up activities, findings, and next steps
• Identify trends or recurring issues, escalating concerns to supervisors or appropriate internal teams to support process improvement

Skills/Experience Required

• Education: High School Diploma or equivalent required
• Strong computer skills, including working knowledge of MS Outlook, Word, and Excel
• Ability to type 40 WPM with accuracy
• Proven ability to handle high-volume workloads, prioritize effectively, and meet tight deadlines
• Experience in a structured environment where call monitoring, performance metrics, or productivity scoring are used is helpful
• Strong verbal communication skills with the ability to remain calm, professional, and effective during phone interactions with insurance carriers
• Excellent written communication skills for crafting clear, accurate documentation and correspondence
• Exceptional attention to detail and accuracy in reviewing claims, identifying discrepancies, and documenting findings
• Highly organized, self-paced, and capable of managing work independently in a remote environment
• Dependable, punctual, and accountable, with a willingness to ask questions and seek clarification when needed
• Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment

Physical Requirements

• Ability to talk, hear, and see clearly to read and interpret information
• Regular use of a computer, phone, and standard office equipment
• May be required to travel for business purposes
• Ability to secure confidential information
• Perform all duties in a professional environment free of noise or anything that would create a negative customer experience

Work environment characteristics

• Regular use of a computer, phone, and standard office equipment
• May be required to travel for business purposes
• Ability to secure confidential information
• Perform all duties in a professional environment free of noise or anything that would create a negative customer experience

Benefits

A competitive salary, commensurate with experience, along with a comprehensive benefits package, including 401(k) Plan.

Equal Opportunity Employer

We offer a competitive salary, commensurate with experience, along with a comprehensive benefits package, including 401(k) Plan. EO/M/F/Veterans/Disabled. Our mission is to be the best partner for those who save and improve patients’ lives. Excellence in delivering upon our mission is dependent upon having a diverse team that is empowered to bring their full, authentic self to work each day. We strive to create a workplace that reflects the communities we serve, and we are passionate about creating an inclusive workplace that promotes and values diversity.