Remote Jobs RockRemote Jobs Rock

Health Claims Specialists

🕒 2 days ago
Medical Claims AdjudicationData EntryMedical Billing And CodingInsurance Claims
Apply Now

📜 Description

  • Adjudicate claims according to client requirements, policies, procedures, and regulatory guidelines.
  • Meet production, quality, and other performance targets during and after training.
  • Follow up on claims that need additional information and refer complex cases for review.
  • Maintain accurate, confidential claim information in accordance with privacy guidelines.
  • Use claims software and take on special projects as assigned.

🛠️ Requirements

  • High School Diploma or equivalent
  • Medical Billing and Coding degree/certification.
  • Previous experience in a medical office type setting, including some knowledge of insurance, claims, billing or coding, with an understanding of the different types of insurance (Medicare/Medicaid and/or Child Plus).
  • Knowledge of Medical terminology

✨ Benefits

  • & recognition programs.
  • Employee Discounts.
  • EAP and Health and Wellness programs including a personal trainer dedicated to Sutherland.
  • Weekday schedule, Monday – Friday 8:30 AM – 5:00 PM EST.
  • Data entry
  • Time management
  • Attention to detail
  • Analytical
  • Process medical claims through data entry for most of the workday.
Full job description

Company Description

This is a full-time permanent healthcare claims adjudicator position. A claims adjudicator determines how much money will be paid after an insurance claim has been examined. This is not a customer service or customer facing position. This is a data entry position where you will be processing medical claims per the specific client requirements. Claims can vary and are highly customized depending on the service level.  You will work independently with the assistance of knowledge base and support personnel. You will also be expected to meet all Key Performance Indicators and Quality goals throughout Training and beyond.

Job Description

What you will be doing as a Claims Examiner:

  • Work independently, processing claims via data entry for 90% of your day.
  • Be responsible for effectively adjudicating claims to meet production, quality, and other metrics in accordance with policy/procedures and regulatory guidelines
  • Follow up on claims needing additional information
  • Refer problem claims to a Lead and/or auditor for additional review
  • Make sure that the integrity of the information is accurate and kept private according to HIPPA guidelines
  • Work with specific software
  • May be assigned special projects

 

When you join us, you’ll enjoy:

  • Pay rate of $13.50/hour with the opportunity to bonus an additional $1500 a month.
  • Medical, dental, and vision plans.
  • Paid training and PTO (be sure to ask about our Global Flexible Vacation Policy).
  • Company-provided equipment.
  • Advancement opportunities – 80% of our frontline leaders have been promoted from within.
  • Monthly rewards & recognition programs.
  • Employee Discounts.
  • EAP and Health and Wellness programs including a personal trainer dedicated to Sutherland.
  • Weekday schedule, Monday – Friday 8:30 AM – 5:00 PM EST.

Qualifications

Skills

  • Data entry
  • Time management
  • Attention to detail
  • Analytical

Required Qualifications

  • High School Diploma or equivalent
  • Excellent Internet Connectivity:
    • Internet access speed of 2 Mbps upload and 10 Mbps download – the faster the better.
      • house network, and a hard-wired internet connection capable of continuously supporting outstanding call quality and high-speed response rates. (Wireless and/or satellite Internet Service Providers are not compatible with our systems)
    • A quiet and distraction-free, secure place to work
    • Effective verbal and written communication skills
    • Strong typing and analytical abilities
    • Multi-tasking skills with a strong attention to detail
    • Computer knowledge
    • Minimum 40 words per minute on typing test
    • Must have and maintain a clean and paper free work environment to meet our company policies.
       
  • Medical Billing and Coding degree/certification.
  • Previous experience in a medical office type setting, including some knowledge of insurance, claims, billing or coding, with an understanding of the different types of insurance (Medicare/Medicaid and/or Child Plus).
  • Knowledge of Medical terminology

Additional Information

All your information will be kept confidential according to EEO guidelines.

EEOC and Veteran Documentation
During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.
At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all 
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.

Manage operational processes and project workflows by maintaining documentation, organizing files, preparing reports, communicating with clients and vendors, and coordinating tasks across teams.

📍 🇪🇨 Ecuador - Remote💰 $1.0k / month💼 Full-Time🎹 Mid-level📅 Project Manager📢 🇬🇧 English Required📢 🇪🇸 Spanish Required
OperationsProject CoordinationProcess DocumentationProcess Improvement
Casm-Limitlessli

Claims Assistant

🕒 2 days ago
Casm-Limitlessli👥 51 - 200 employees🏢 Staffing And Recruiting

Process new Workers’ Compensation claims by reviewing documentation, entering and verifying claim data, and maintaining accurate records to support timely and efficient claims administration.

Claims ProcessingWorkers’ Compensation ClaimsData EntryClaims Management Systems
Sourcefit

Roof Measurement Specialist

🕒 2 days ago
Sourcefit👥 501 - 1000 employees🏢 Outsourcing/offshoring

The Roof Measurement Specialist uses specialized software to capture and document roof measurements, label structural features, assign pitches, and deliver accurate reports to clients and stakeholders.

Roof MeasurementRoofing TerminologyRoof Structure IdentificationRoofer Platform

Review client documents, reconcile 401(k) plans, complete plan testing and year-end reporting, and prepare government filings while keeping clients informed and helping them understand plan administration.

Document ReviewTransaction ProcessingBack-office Financial OperationsMicrosoft Excel

Trusted by Remote Workers