Health Insurance Claims Representative

Job Summary

Processing health insurance claims remotely, the full-time Associate Claims Representative will validate claims, ensure accuracy, and determine coverage based on defined workflows.

Key responsibilities

• Release health insurance claims for payment and validate them for completeness and accuracy
• Review claims using medical necessity and eligibility guidelines to determine coverage and benefit levels
• Respond to information requests from other departments and refer complex claims to senior representatives

Required qualifications

• High school diploma or equivalent required; some college coursework preferred
• One year of applicable experience required, with medical claims processing experience preferred
• Demonstrable computer literacy and basic knowledge of Microsoft Office
• Analytical ability with a keen attention to detail
• Ability to maintain confidentiality and a desire to learn