Claims Specialist - 257439

Claims Specialist – Out-of-Network Claims

Remote – Must Reside Arizona | $22–$24/Hour | Out-of-Network Experience REQUIRED

MUST HAVE OUT-OF-NETWORK BILLING/CLAIMS EXPERIENCE

Remote – Arizona Residents Only

$22–$24/hour

Equipment Provided

Monday–Friday

Monthly Bonus Potential

About the Role

We are seeking an experienced Claims Specialist with a strong background in OUT-OF-NETWORK BILLING AND CLAIMS to join a collaborative team specializing in air ambulance claims, member appeals, and insurance reimbursement.

Out-of-network claims experience is a hard requirement for this position. Candidates must have hands-on experience working with out-of-network insurance claims and reimbursement . This is not a role where out-of-network billing can be learned from scratch.

Air ambulance experience is a plus, but extensive training will be provided on the specific air ambulance processes. What we need you to already bring is a strong foundation in out-of-network claims, medical A/R, collections, and revenue cycle management.

This is a detail-oriented role for someone who enjoys investigating complex claims, communicating with insurance companies and patients, and finding solutions rather than simply processing claims.

Key Responsibilities

• Manage approximately 25–30 insurance claims per day
• Work extensively with OUT-OF-NETWORK CLAIMS and reimbursement
• Research complex claim issues and determine appropriate resolution
• Navigate commercial insurance requirements and out-of-network reimbursement processes
• Perform eligibility and benefits verification
• Apply air ambulance-specific eligibility and reimbursement criteria
• Investigate and process member appeals
• Gather and submit prior authorizations, medical records, and supporting documentation
• Communicate with patients, families, employers, and insurance providers by phone, email, and online chat
• Follow up with insurance companies regarding claim status, reimbursement, and outstanding issues
• Maintain detailed and accurate claim documentation
• Track productivity and quality metrics
• Collaborate with the team and escalate complex issues appropriately
• Proactively identify problems and ask questions when additional support is needed

Required Qualifications

OUT-OF-NETWORK BILLING/CLAIMS EXPERIENCE — REQUIRED

• 2+ years of A/R and collections experience
• Hands-on experience with OUT-OF-NETWORK medical billing/claims — REQUIRED
• Experience working with commercial insurance
• Strong understanding of insurance claims and reimbursement processes
• Strong critical-thinking and problem-solving abilities
• Excellent verbal and written communication skills
• Strong attention to detail
• Ability to investigate complex claims rather than simply follow a repetitive workflow
• Comfortable working across multiple systems and researching claim information
• Adaptable, inquisitive, and willing to ask questions and escalate issues appropriately
• Ability to work independently while contributing to a collaborative team

Preferred Experience

• Air ambulance billing or claims
• Hospital billing / RCM
• Critical care billing
• Single-specialty healthcare billing
• Medical collections
• Member appeals
• Prior authorization
• Medical record requests

Important Candidate Requirement

OUT-OF-NETWORK CLAIMS EXPERIENCE IS A MUST-HAVE.

We are specifically looking for candidates who have personally worked on out-of-network billing/claims and understand the challenges of obtaining reimbursement from commercial insurance plans.

Candidates with only in-network billing experience will not be considered for this position.

Air ambulance experience is preferred but not required — we will train the right candidate on the air ambulance-specific aspects of the role.

Training & Schedule

Initial Training:

• Approximately 90 days
• Monday–Friday, 6:00 AM–3:00 PM Arizona time
• 8-hour shift with a 30-minute lunch
• Fully virtual training through Microsoft Teams
• Interactive training with screen sharing and ongoing support

Post-Training:

• Monday–Friday
• Flexible start time between 6:00 AM–8:00 AM Arizona time
• Consistent start time once selected

Remote Work

Remote – Arizona

• Must reside in Arizona
• Approximately 1 onsite day per month at the North Scottsdale office
• Equipment must be picked up in person on the first day
• Company provides:
• Laptop
• Monitor
• Keyboard
• Mouse
• Headset
• Must have a reliable internet connection and HIPAA-compliant workspace