Job Title: Claims Processor

Location: Remote (U.S.-based)
Reports To: Claims Manager

Position Summary:

The Claims Processor is responsible for accurately and efficiently reviewing, entering, and adjudicating medical, dental, and vision claims in accordance with plan documents and company procedures. This role requires a strong attention to detail, understanding of benefit plan provisions, and the ability to meet production and accuracy standards while maintaining confidentiality and compliance with HIPAA regulations.

Key Responsibilities:

Review incoming claims for completeness, accuracy, and eligibility under applicable plan provisions.
Enter and process claims in the system within established turnaround times and accuracy standards.
Verify member and provider information, coverage levels, and plan benefits.
Apply correct coding, pricing, and benefit rules (including CPT, ICD, and HCPCS where applicable).
Identify discrepancies or missing information and follow up with providers, members, or internal departments to ensure resolution.
Process claim adjustments, re-evaluations, and coordination of benefits as required.
Maintain compliance with all HIPAA and privacy regulations.
Assist with resolving claim-related inquiries from providers, members, and internal teams in a professional and timely manner.
Contribute to continuous improvement initiatives to enhance claims processing accuracy and efficiency.

Qualifications:

Education and Experience:

High school diploma or equivalent required; Associate degree preferred.
1–3 years of experience in medical, dental, or vision claims processing (TPA or health insurance experience strongly preferred).

Skills and Competencies:

Strong attention to detail and commitment to accuracy.
Knowledge of medical terminology, coding, and standard benefit administration practices.
Proficient in Microsoft Office Suite (Excel, Outlook, Word) and claims processing systems.
Strong analytical, problem-solving, and organizational skills.
Ability to work independently in a remote environment while meeting deadlines and productivity goals.
Excellent written and verbal communication skills.
Ability to maintain confidentiality and adhere to compliance standards at all times.

Work Environment:

Fully remote position (must have reliable internet access and a quiet workspace).
40-hour work week, with a full 8-hour workday. Our operating hours are as follows: Monday–Friday: 7:00 a.m. CST – 5:30 p.m. CST
Minimal physical demands, primarily computer-based work.

Compensation and Benefits:

Pay Range: $22.00 – $25.00 per hour, based on experience and qualifications.
Benefits Include:
Medical, Dental, and Vision Insurance
Company-paid Life Insurance
Paid Time Off and Holidays
Remote Work Flexibility

Job Type: Full-time

Pay: $20.00 - $25.00 per hour

Expected hours: 40 per week

Benefits:

Dental insurance
Paid time off
Vision insurance

Application Question(s):

Please provide one professional reference we may contact.

Include their full name, phone number, and relationship to you (coworker, mentor, etc.)

Please describe your experience processing claims and how you ensured accuracy and compliance in your work.
This role requires processing a high volume of claims daily with strong attention to detail. Please share the average or approximate number of claims you processed per day in previous roles.

What systems, platforms, or software have you used in claims processing?

Work Location: Remote

Employee Benefits Consulting

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