REMOTE Medical Claims Representative

TEKsystems • Raleigh, NC

15h • $21 - $23 • Remote

About The Position

The Remote Customer Service Representative (CSR) provides timely, accurate, and customer‑focused benefit and claim support for a variety of supplemental health insurance products. These products include SB Medical, Accident, Critical Illness, Hospital Indemnity, Prescription, Dental, Vision, and MEC plans. This role is heavily focused on claims intake and customer support, requiring strong medical claims knowledge, high attention to detail, and the ability to manage a high call volume in a remote call‑centre environment.

Requirements

• 1–2+ years of experience working with health insurance claims and benefits, specifically: Scheduled Accident, Critical Illness, Hospital Indemnity
• Medical claims processing experience involving: Doctor visits, Diagnostic testing, Hospital stays
• Strong knowledge of CPT, HCPCS, Revenue Codes, and ICD‑10
• Hands‑on experience reading and interpreting: HCFA 1500, UB‑04
• Ability to review and understand medical records and Explanation of Benefits (EOBs)
• 1+ year of call centre experience
• Comfortable working in a high‑volume, metric‑driven environment
• Medical Claims Processing
• Health Insurance & Supplemental Benefits
• Customer Service (Call Centre)
• Claims Intake & Registration
• Medical Billing & Revenue Cycle
• Appeals & Denials
• CPT / ICD‑10 Coding
• HCFA 1500 & UB‑04 Forms

Nice To Haves

• Remote experience strongly preferred

Responsibilities

• Handle an average of 40–50 inbound customer service calls per day
• Provide clear, accurate information regarding benefits, claims status, and coverage
• Collect and enter all required claim information accurately and efficiently
• Document detailed call summaries in the claims system ensuring clarity and accuracy
• Issue timely and accurate claim acknowledgement correspondence
• Process incoming documentation with high coding integrity and route appropriately
• Accurately register and enter incoming medical claims
• Meet or exceed productivity and quality metrics
• Process approximately 20 claims per day
• Perform other tasks or projects as assigned by management

Benefits

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed
• Number of Employees: 501-1,000 employees