Claims Processor - Work from Home

Sagility

1d•$17•Remote

About The Position

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries. Job Description: BroadPath, a Sagility Company, is hiring experienced medical Claims Processors to join our remote team! Claims Processors are responsible for the accurate and timely entry, review, and resolution of medical claims ranging from simple to moderately complex. This includes reviewing front-end claims and validating information submitted by patients or providers seeking reimbursement from the insurance company. All claim processing must align with CMS guidelines and client-specific policies and procedures. Schedules, pay rates, and program details may vary based on business needs and client assignment. Compensation Highlights Base Pay: Starting at $17 per hour Pay frequency: Weekly pay Schedule Highlights Schedules can fall between the hours of Monday-Friday, 8:00 AM - 10:00 PM Eastern Time, and will be assigned based on business needs At BroadPath, a Sagility Company, we believe that transparency, authenticity, and collaboration are the keys to building strong, connected remote teams. Being on camera is an integral part of our culture. It is how we build relationships, share ideas, and stay engaged. If you are someone who values open communication, connection, and teamwork, you will thrive in our environment where showing up authentically matters. What to Expect: On-camera participation during interviews, training, team meetings, and regular check-ins. Face-to-face discussions sparking collaboration and engagement A supportive atmosphere where you can express yourself openly and be part of a team that values your contributions. Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries. Already keen? Discover your next role with Sagility, a great place to work.

Requirements

Minimum of one year of recent experience processing medical claims for a health insurance company or payer
Familiarity with medical claim forms (CMS-1500 and UB-04)
Working knowledge of coding systems: ICD-10, HCPCS, and CPT
Proficient in computer navigation and technology, including Microsoft Windows, Excel (advanced functions), and web-based tools and platforms
Excellent verbal and written communication skills
Ability to remain focused and productive in a high-volume, repetitive task environment
High School Diploma or equivalent

Responsibilities

Review medical claims thoroughly to ensure no missing or incomplete information
Navigate multiple computer systems and platforms to research and process assigned claims accurately (e.g., verifying pricing, prior authorizations)
Apply appropriate benefits to each claim in accordance with claims processing policies, including grievance procedures, state mandates, CMS guidelines, and benefit plan documents
Review documentation to assess whether the visit was necessary and whether the policy covers the treatment received
Determine if claims should be paid or denied, and complete denial letters when applicable