Claims Processing Representative

Job Summary

Processing health insurance claims, the full-time Claims Processing Representative will manage both paper and electronic submissions, ensuring accuracy and compliance with defined workflows while working remotely.

Key responsibilities

• Process health insurance claims and adjustments based on appeals and benefit changes
• Evaluate claims requiring additional information and determine applicable benefit levels
• Mentor teammates and communicate findings regarding claims processing issues

Required qualifications

• High school diploma or equivalent required; associate degree preferred
• Two years of applicable experience required, with a preference for medical claims processing experience
• Knowledge of benefits, summary plan documents, and explanation of benefits