Health Claims Specialists

Company

Description:

This is a full‑time permanent healthcare claims adjudicator position. A claims adjudicator determines how much money will be paid after an insurance claim has been examined. This is not a customer‑service or customer‑facing position. It is a data‑entry role where you will process medical claims per the specific client requirements. Claims can vary and are highly customized depending on the service level.

You will work independently with the assistance of a knowledge base and support personnel. You will also be expected to meet all Key Performance Indicators and Quality goals throughout training and beyond.

• Work independently, processing claims via data entry for 90% of your day.
• Be responsible for effectively adjudicating claims to meet production, quality, and other metrics in accordance with policy/procedures and regulatory guidelines.
• Follow up on claims needing additional information.
• Refer problem claims to a Lead and/or auditor for additional review.
• Ensure the integrity of information is accurate and kept private according to HIPPA guidelines.
• Work with specific software.
• May be assigned special projects.

• Pay rate of $13.50/hour with the opportunity to earn an additional $1,500 a month in bonuses.
• Medical, dental, and vision plans.
• Paid training and PTO (please ask about our Global Flexible Vacation Policy).
• Company‑provided equipment.
• Advancement opportunities – 80% of our frontline leaders have been promoted from within.
• Monthly rewards & recognition programs.
• Employee discounts.
• EAP and Health and Wellness programs including a personal trainer dedicated to Sutherland.
• Weekday schedule, Monday – Friday 8:30 AM – 5:00 PM EST.

• Skills:
  • Data entry
  • Time management
  • Attention to detail
  • Analytical thinking
• Required Qualifications:
  • High School Diploma or equivalent
  • Excellent Internet connectivity (minimum 2 Mbps upload, 10 Mbps download; wired connection preferred)
  • Quiet, distraction‑free, secure place to work
  • Effective verbal and written communication skills
  • Strong typing and analytical abilities (minimum 40 words per minute)
  • Multi‑tasking skills with strong attention to detail
  • Computer knowledge
  • Maintain a clean, paper‑free work environment
• 
  
  Preferred Experience /
  
  Certifications:
  
  
  • Medical Billing and Coding degree/certification
  • Previous experience in a medical office or related setting (knowledge of Medicare, Medicaid, and/or Child Plus)
  • Knowledge of medical terminology

All your information will be kept confidential according to EEO guidelines.

EEOC and Veteran documentation:
During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status. Government agencies may require periodic reports on employee protected status; compliance is solely for statistical and regulatory purposes. Participation in such reporting is voluntary and will not influence employment decisions.