Claims Processor

Sagility

Claims Processor responsible for reviewing and processing medical claims for health insurance. Working remotely to ensure accuracy and compliance with CMS guidelines.

Posted 6/17/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $17 per hourWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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.

Benefits

Comp & perks

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.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical claims processingICD-10HCPCSCPTCMS-1500UB-04claims processing policiesgrievance proceduresbenefit plan documents

Soft Skills

verbal communicationwritten communicationfocusproductivityability to work in high-volume environment

Certifications

High School Diploma