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Claims Specialist

1 hour, 45 minutes ago
South Africa
Full-time
Junior
Operations Specialist
Operations
Apply Now
Reworks Solutions

Reworks Solutions

ReWorks Solutions provides rigorously vetted, native English-speaking remote professionals backed by white-glove management and proactive support.

Internet Software & Services
View All Jobs 35

Description

  • Process and adjudicate insurance claims in accordance with company policies and regulations.
  • Review claims to identify discrepancies, issues, and items requiring resolution.
  • Communicate with insurance companies, healthcare providers, and patients regarding claims inquiries and disputes.
  • Collaborate with internal teams to gather documentation and information needed to support claim decisions.
  • Maintain detailed records of claims activity and track outstanding claims through timely follow-up.
  • Monitor industry changes and payer policies to improve claims processing and reimbursement rates.

Requirements

  • Associate's degree in healthcare administration, business, or a related field; bachelor's degree preferred.
  • Minimum of 2 years of experience in claims processing or a related healthcare role.
  • Strong understanding of medical terminology, CPT, ICD-10, HCPCS, and insurance policies.
  • Excellent analytical skills with strong attention to detail.
  • Proficiency with claims management software and electronic health record (EHR) systems.
  • Strong verbal and written communication skills for working with stakeholders.
  • Ability to work independently in a remote environment and manage time effectively to meet deadlines.
  • Availability to work U.S. hours, 9am-5pm EST.

Benefits

  • Full-time remote work from home.
  • Comfortable working U.S. hours.
  • Fraud protection notice: ReWorks Solutions states it will never request payment during recruitment or require in-person office visits.
  • Official communication is provided only through a ReWorks Solutions email address.

Interested in this position?

Apply directly on the company website

Apply Now

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