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Health Claims Specialists- Remote
Sutherland - Raleigh, NC
posted about 2 months ago
About the position
The Health Claims Specialist position at Sutherland Global Services is a full-time, permanent role focused on processing medical claims through data entry. The primary responsibility is to adjudicate claims accurately and efficiently, ensuring compliance with policy, procedures, and regulatory guidelines. This role does not involve customer service interactions and requires independent work with support from a knowledge base and personnel. The position emphasizes meeting key performance indicators and quality goals throughout training and beyond.
Responsibilities
- Process claims via data entry for 90% of the workday.
- Adjudicate claims to meet production, quality, and other metrics according to policy and regulatory guidelines.
- Follow up on claims requiring additional information.
- Refer problem claims to a Lead or auditor for further review.
- Ensure the integrity and privacy of information according to HIPAA guidelines.
- Utilize specific software for claims processing.
- May be assigned special projects.
Requirements
- Health or health insurance claims experience.
- Knowledge of medical terminology.
- Some experience in a medical office setting.
- Accurate typing speed of 40 WPM.
Nice-to-haves
- Experience with claims adjudication software.
- Familiarity with HIPAA regulations.
Benefits
- Salary of $13.50/hour + monthly incentives up to $1500/month.
- Monthly rewards & recognition programs.
- Medical, dental, and vision benefits.
- Paid training & PTO.
- Cross program and advancement opportunities.
- Employee Discounts.
- EAP & Health and Wellness programs including a personal trainer.
