Claims Process Executive (remote)
About The Position
Join our team as a Claims Processing Executive in the healthcare sector where you will utilize your expertise in MS Excel to efficiently manage and process commercial claims. This remote position offers the flexibility of working from home during day shifts allowing you to balance work and personal commitments effectively. Your contributions will directly impact the accuracy and efficiency of our claims processing enhancing customer satisfaction and operational excellence. You will report to our office in Winston-Salem, NC for 6 weeks to complete our training regimen, this takes place Monday-Friday from 8-5pm EST.
Requirements
- High school diploma or equivalent REQUIRED
- Strong knowledge of US healthcare insurance systems (Medicare, Medicaid, commercial payers).
- 2-4 years of experience in US healthcare claims processing
- Familiarity with claims management software and EDI transactions.
- Excellent analytical, organizational, and communication skills.
- Ability to interpret insurance policies and payer guidelines.
- Detail-oriented with strong problem-solving abilities.
Responsibilities
- Claims Processing: Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies.
- Eligibility Verification: Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans.
- Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
- Compliance: Maintain adherence to HIPAA regulations, CMS guidelines, and other US healthcare compliance standards.
- Documentation: Record claim activity, maintain audit trails, and prepare reports for management.
Benefits
- Medical/Dental/Vision/Life Insurance
- Paid holidays plus Paid Time Off
- 401(k) plan and contributions
- Long-term/Short-term Disability
- Paid Parental Leave
- Employee Stock Purchase Plan
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
