Claims Processor
Sagility
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $17 per hour
Job Level
About the role
- 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.
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.
- High School Diploma or equivalent.
Benefits
- Medical, Dental, and Vision coverage.
- Life Insurance.
- Short-Term and Long-Term Disability options.
- Flexible Spending Account (FSA).
- Employee Assistance Program.
- 401(k) with employer contribution.
- Paid Time Off (PTO).
- Tuition Reimbursement.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical claims processingICD-10HCPCSCPTCMS-1500UB-04claims processing policiesgrievance proceduresbenefit plan documents
Certifications
High School Diploma