Claims Representative

Job Description

REQUIREMENTS

• High school diploma or equivalent
• Ability to quickly learn new systems and processes
• Experience using Microsoft Outlook (email, calendar invites, attachments)
• Basic Microsoft Excel skills (sorting/filtering)
• Ability to navigate multiple systems using shortcuts and efficient workflows
• Strong attention to detail and ability to follow complex procedures
• Excellent time management and organizational skills
• Ability to meet productivity and quality performance expectations
• Experience working independently in a remote environment preferred
• Familiarity with healthcare terminology, insurance claims, CPT or ICD-10 coding preferred
• Previous claims processing or related administrative experience preferred
• Must be at least 18 years of age
• Minimum 1 year of consistent employment history (customer service or administrative experience preferred)
• Reliable attendance required, especially during the first 90 days
• Typing speed of at least 25 WPM
• Hardwired internet connection with minimum speeds of 25 Mbps download and 10 Mbps upload
• Secure, private workspace free from distractions
• Flexible availability, including weekends as business needs require

RESPONSIBILITIES

• Review and process insurance claims accurately using internal guidelines and benefit plans
• Research and navigate multiple systems and documents to validate claim details
• Confirm required documentation is included and identify missing information
• Verify accuracy of medical coding (CPT/ICD-10 preferred)
• Evaluate eligibility, coverage, authorizations, and coordination of benefits
• Identify discrepancies and resolve errors using established procedures
• Maintain productivity and quality standards in a fast-paced environment
• Work independently while collaborating with supervisors, coaches, and trainers
• Use multiple computer applications and virtual tools such as Outlook, Webex, and internal systems
• Continuously improve efficiency through feedback and training support

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