Claims Processor

Health Admins

Claims Processor managing and optimizing medical claims processing for a leading healthcare administration firm. Collaborating to enhance service delivery and ensure compliance with regulations.

Posted 5/16/2026full-timeRemote • Texas • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Review and process medical claims submitted by members or providers promptly and accurately.
Verify the accuracy and completeness of claim information, including patient demographics, diagnoses, procedures, and billing codes when available.
Ensure compliance with insurance policies and industry standards.
Investigate and resolve any discrepancies or issues related to claim submissions.
Conduct comprehensive medical claims audits to identify errors, discrepancies, or fraudulent activities.
Analyze claim documentation, including medical records and billing statements, to ensure adherence to coding guidelines and reimbursement policies.
Research complex medical billing and coding issues to support claims processing and audit activities.
Interpret coding guidelines, reimbursement policies, and legal requirements to determine appropriate claim adjudication.
Provide recommendations for improving claims submission procedures and enhancing reimbursement accuracy.
Serve as members' primary point of contact regarding claims inquiries and resolution.
Respond promptly to customer inquiries and concerns with professionalism and empathy.
Collaborate with cross-functional teams to address customer issues and ensure timely resolution.

Requirements

What you’ll need

High School Diploma or equivalent
Proven experience in medical claims processing and healthcare reimbursement
Strong knowledge of medical terminology, medical coding, and insurance billing practices
Technical Knowledge: SalesForce Experience, Google Suite Experience, Claims Management Software experience
Excellent analytical skills with the ability to interpret complex healthcare regulations and guidelines
Exceptional attention to detail and accuracy in data entry and documentation
Effective verbal and written communication skills with a customer-centric approach
Must be a self-motivator and self-starter
Exceptional listening and analytical skills
Solid time management skills
Ability to multitask and successfully operate in a fast paced, team environment
Must adapt well to change and successfully set and adjust priorities as needed

Benefits

Comp & perks

Competitive salary and benefits package
Dynamic and innovative work environment
Opportunities for professional growth and development
Remote work

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical claims processingmedical codinginsurance billing practicesdata entryclaims auditsbilling codeshealthcare reimbursementanalytical skillsattention to detailcustomer service

Soft Skills

effective communicationcustomer-centric approachself-motivatortime managementmultitaskingadaptabilityproblem-solvingteam collaborationlistening skillsprofessionalism