Claims Processor- 100% Remote

About Our Client

The organization operates in the medical claims management industry, addressing inefficiencies in insurance claims processes within the auto insurance and workers' compensation sectors. By combining specialized medical expertise, established procedures, and innovative technology, the company supports auto insurance carriers, third-party administrators, and government entities in reducing costs and improving claims-processing efficiency.

About the Opportunity

The Claims Processor is responsible for reviewing, managing, and documenting insurance claims to ensure accurate and timely processing. This position involves verifying coverage, reviewing claim documentation, supporting dispute and litigation activities, and processing payments in accordance with applicable requirements. The role is essential to maintaining an efficient claims workflow while supporting legal, litigation, and operational teams.

Responsibilities

• Conduct account searches and obtain applicable police reports.
• Make initial contact following notice of loss and accurately document claim files.
• Send claim forms to claimants, insured parties, and authorized representatives.
• Review claim files to ensure appropriate reserves and required documentation are maintained.
• Request missing information and documentation needed to properly manage claims.
• Support litigation and legal departments with disputes, appeals, and pre-suit actions.
• Assist with post-service appeals, assignments, dispute awards, settlements, and withdrawals.
• Process payments related to awards, settlements, and applicable interest.
• Redirect documentation when claims cannot be located within the system.
• Conduct cycle-time reviews for missing or pending documentation, open billing, and claim closure.

Requirements

• Bachelor's degree or equivalent relevant experience.
• Prior experience with an insurance carrier or as a claims adjuster.
• 2–3 years of experience with New Jersey No-Fault PIP regulations preferred.
• Minimum of 2 years of medical billing or claims processing experience.
• Strong organizational skills and attention to detail.
• Professional and sensitive communication skills when interacting with claimants and other stakeholders.
• Familiarity with claims systems, procedures, and documentation requirements.
• Ability to maintain confidentiality when handling sensitive information.
• Proficiency with Microsoft Office Suite.
• Ability to manage daily operations while adhering to established SOPs and client service-level agreements.