Claims Research Resolution Rep

📋 Description

• Investigate, research, and resolve complex medical claims issues by working with healthcare
• Review claims discrepancies, validate supporting documentation, and apply established policies
• Collaborate with claims specialists, call center representatives, provider associates, and other
• Respond to claims inquiries through various communication channels, adapting to changing workloads
• Apply sound judgment, discretion, and in-depth knowledge of claims processes to determine effective
• Maintain accurate records of investigations, decisions, and resolution activities while ensuring

🎯 Requirements

• At least one year of healthcare customer service experience.
• At least one year of call center experience.
• Intermediate proficiency in Microsoft Excel, including the ability to organize, review, and analyze
• Intermediate proficiency in Microsoft Word for documentation and administrative tasks.
• Working knowledge of healthcare terminology and medical claims processes.
• Familiarity with Medicare or Medicaid claims and related healthcare procedures.

🎁 Benefits

• Competitive annual salary: $43,000–$56,200, depending on qualifications, relevant experience
• Remote work opportunity: Work from home within an eligible U.S. location, subject to operational
• Healthcare coverage: Medical, dental, and vision insurance.
• Retirement savings: Access to a 401(k) retirement savings plan.
• Paid time off: Paid leave, company holidays, and personal holidays.
• Family support: Paid parental and caregiver leave.