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
