Health Claims Specialists

Sutherland • Louisville, KY

9d

About The Position

This is a full-time, permanent healthcare claims adjudicator position. The role examines and processes medical claims through data entry according to specific client requirements. Claims and service levels may vary and be highly customized. This is not a customer service or customer-facing role. Employees work independently with support from a knowledge base and support personnel, and are expected to meet key performance indicators and quality goals during training and afterward.

The schedule is Monday through Friday, 8:30 AM to 5:00 PM EST. The position offers $13.50 per hour, with the opportunity to earn an additional $1,500 per month in bonuses. Required setup includes reliable, hard-wired internet and a quiet, secure, distraction-free workspace that meets company policies.

Requirements

• High school diploma or equivalent.
• Internet access with at least 2 Mbps upload and 10 Mbps download; wireless and satellite internet providers are not compatible.
• A hard-wired internet connection capable of supporting high-speed response rates and call quality.
• A quiet, distraction-free, secure place to work.
• Effective verbal and written communication skills.
• Strong typing and analytical abilities.
• Ability to multitask with strong attention to detail.
• Computer knowledge.
• Minimum typing speed of 40 words per minute on a typing test.
• Medical Billing and Coding degree or certification.
• Previous experience in a medical-office-type setting, including some knowledge of insurance, claims, billing, or coding.
• Understanding of different types of insurance, such as Medicare/Medicaid and/or Child Plus.
• Knowledge of medical terminology.
• Ability to meet production, quality, and other performance metrics.

Nice To Haves

• Faster internet access than the stated minimum.

Responsibilities

• Process claims through data entry for approximately 90% of the workday.
• Adjudicate claims in accordance with policies, procedures, and regulatory guidelines while meeting production, quality, and other metrics.
• Follow up on claims that require additional information.
• Refer problem claims to a lead and/or auditor for additional review.
• Maintain accurate and private information in accordance with HIPAA guidelines.
• Work with specific software.
• Complete special projects when assigned.
• Meet key performance indicators and quality goals during training and beyond.
• Maintain a clean, paper-free work environment in accordance with company policies.

Benefits

• Medical, dental, and vision plans.
• Paid training.
• Paid time off (PTO); the posting also invites candidates to ask about the Global Flexible Vacation Policy.
• Company-provided equipment.
• Advancement opportunities, with 80% of frontline leaders promoted from within.
• Monthly rewards and recognition programs.
• Employee discounts.
• Employee Assistance Program (EAP).
• Health and wellness programs, including access to a personal trainer.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED