Claims Representative

About Our Client

The organization operates within the healthcare sector, focusing on delivering care supported by technology to improve health outcomes. It addresses the challenge of connecting people with necessary care, pharmacy benefits, data, and resources to support healthier lives. The organization works on a global scale, aiming to advance health optimization and impact communities by mitigating barriers to good health and promoting equitable care.

About the Opportunity

The Claims Representative plays a critical role in supporting claims processing teams by reviewing, researching, negotiating, and adjusting claims. This position ensures accurate claims payment and resolves claims-related issues, directly contributing to the organization's goal of delivering effective healthcare services. The role supports operational efficiency and improves the overall claims experience for members and providers.

Responsibilities

• Review, research, and obtain necessary information to process or resolve claims issues
• Ensure appropriate benefits are applied to each claim
• Apply customer service standards and knowledge of service agreements to claims processing
• Identify and apply knowledge of new plans or customers for accurate claims handling
• Detect and resolve claims processing errors and trends related to systems, eligibility, vendors, or providers
• Address new or unusual claims errors using prior experience
• Communicate clearly with external stakeholders to resolve claims issues
• Collaborate with internal teams such as Subject Matter Experts, Network Management, IT, Compliance, and Vendor Management
• Document and report on claims and investigations according to requirements
• Maintain security of sensitive documents
• Meet performance metrics including productivity, quality, and turnaround time

Requirements

• A High School Diploma, GED, or equivalent work experience
• Minimum 18 years of age
• At least 1 year of healthcare claims experience
• Ability to work Monday to Friday, 8:00 AM to 4:30 PM CST, with occasional overtime as needed
• PREFERRED: Experience processing medical, dental, prescription, or mental health claims
• Proficiency in Microsoft Office
• Dedicated, private work area
• Residence with access to approved high-speed internet

Pay Range and Compensation Package

Hourly pay ranges from $18 to $32 based on experience and other relevant factors

Benefits & Perks

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401(k) contributions

Equal Opportunity Statement

Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note: RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.