Remote Jobs
Claims Resolution Specialist
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Job Description
- Req#: 114423
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely with a secure and private workspace compliant with HIPAA standards
- Supportive and collaborative work environment
- Chance to make a positive impact on member experience and satisfaction
- Engage in meaningful work by protecting members from inappropriate financial liability
What to Expect (Job Responsibilities):
- Investigate and resolve member balance billing issues by coordinating with providers, facilities, and internal teams
- Review claims to confirm appropriate processing, payment responsibility, and benefit application
- Communicate directly with providers and members to clarify insurance coverage, benefits, and payment responsibilities
- Document all case activity accurately and promptly in the claims or CRM system
- Educate providers on proper billing practices and health plan policies related to balance billing
What is Required (Qualifications):
- 1+ year of experience in healthcare billing, claims resolution, or health plan operations
- Understanding of PPO, EPO, and other health plan benefit structures
- Excellent written and verbal communication skills, with strong abilities in negotiation and customer service
- Excellent attention to detail and ability to research and analyze claim documentation
- Proficiency with Google Workspace or Microsoft Office tools
How to Stand Out (Preferred Qualifications):
- Knowledge of the No Surprises Act (NSA) and relevant state-level balance billing laws and consumer protections
- Experience working with providers and members to resolve billing disputes
- Familiarity with medical terminology and claim adjudication processes
- Previous experience with claims platforms or CRM systems
#HealthcareServices #ClaimsResolution #RemoteWork #CareerOpportunity #MemberAdvocacy
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