Claims Representative

Job Summary

To support a growing healthcare team, the full-time Claims Representative will manually review and process medical, supplemental, or dental claims remotely, ensuring compliance with established guidelines and meeting performance metrics.

Key responsibilities

• Independently research and navigate documents and databases to accurately process claims
• Validate the accuracy of medical codes and assess eligibility status based on established criteria
• Identify discrepancies and maintain productivity and quality standards while working independently

Required qualifications

• High school diploma or equivalent
• Experience with Microsoft Outlook and basic Excel functions
• Detail-oriented with experience in applying complex policy/procedure documents
• Proven experience in health insurance claims processing or a similar field preferred
• Knowledge of CPT/ICD-10 codes is preferred