Claims Processor (Remote)

A healthcare company is seeking five Claims Processors for Remote contract engagements to provide additional capacity during their peak claims season. In this role, you will primarily support the Care Card queue by reviewing member-submitted documentation, validating transactions against the applicable customer configuration and plan design, and approving or denying claims.


Responsibilities:

• Process 53+ claims each working day while maintaining a quality assurance score of 93% or higher

• Review Care Card transactions and confirm that member-submitted documentation matches the transaction amount

• Validate that expenses are eligible under the applicable customer configuration and plan design

• Approve or deny claims according to established guidelines and notify members of the decision or current claim status

• Respond promptly and empathetically to member questions, primarily through written communication

• Identify discrepancies, research issues and escalate exceptions that cannot be resolved through standard procedures

• Prior claims processing, insurance, healthcare revenue cycle, billing, accounts receivable, banking, mortgage processing or comparable high-volume transaction-processing experience

• Experience succeeding in a fast-paced, metrics-driven production environment

• Highly detail-oriented with the ability to process financial or benefit-related transactions quickly and accurately

• Customer service or member-support experience with exceptional written communication skills and an empathetic approach to a diverse member population

• Ability to work independently in a remote environment while meeting daily productivity and quality expectations

• Healthcare claims, revenue cycle, digital health or benefits administration experience

• Japanese-language proficiency is strongly preferred but not required; Portuguese-language proficiency is also helpful

• Proficiency and comfort using modern cloud-based business and case-management tools