Claims Processor - Work at Home!

BroadPath, a Sagility Company, is hiring experienced medical Claims Processors to join our remote team! Claims Processors are responsible for the accurate and timely entry, review, and resolution of medical claims ranging from simple to moderately complex. This includes reviewing front-end claims and validating information submitted by patients or providers seeking reimbursement from the insurance company. All claim processing must align with CMS guidelines and client-specific policies and procedures. Responsibilities • Review medical claims thoroughly to ensure no missing or incomplete information • Navigate multiple computer systems and platforms to research and process assigned claims accurately (e.g., verifying pricing, prior authorizations) • Apply appropriate benefits to each claim in accordance with claims processing policies, including grievance procedures, state mandates, CMS guidelines, and benefit plan documents • Review documentation to assess whether the visit was necessary and whether the policy covers the treatment received • Determine if claims should be paid or denied and complete denial letters when applicable Qualifications • Minimum of one year of recent experience processing medical claims for a health insurance company or payer • Familiarity with medical claim forms (CMS-1500 and UB-04) • Working knowledge of coding systems: ICD-10, HCPCS, and CPT • Proficient in computer navigation and technology, including Microsoft Windows, Excel (advanced functions), and web-based tools and platforms • Excellent verbal and written communication skills • Ability to remain focused and productive in a high-volume, repetitive task environment • High School Diploma or equivalent What to Expect: • On-camera participation during interviews, training, team meetings, and regular check-ins. • Face-to-face discussions sparking collaboration and engagement • A supportive atmosphere where you can express yourself openly and be part of a team that values your contributions. Benefits: • Medical, Dental, and Vision coverage. • Life Insurance. • Short-Term and Long-Term Disability options. • Flexible Spending Account (FSA). • Employee Assistance Program. • 401(k) with employer contribution. • Paid Time Off (PTO). • Tuition Reimbursement. Pay: $17.00 - $19.00 per hour Benefits: • 401(k) • Dental insurance • Health insurance Application Question(s): • Are you familiar with working on medical claims forms such as CMS-1500 and UB-04? • Do you have working knowledge of coding systems, including ICD-10, HCPCS, and CPT? Experience: • processing medical claims for health insurance or payer: 1 year (Required) Work Location: Remote Apply tot his job

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