Health Insurance Claims Processor

Job Title: Health Insurance Claims Processor

Pay: $20/hrLocation: 100% Remote (must reside in North Dakota, Oregon, Washington, Utah, or Idaho and must work Central Time Zone hours from 8:00AM-4:30PM.)

About the company: They have more than 4,500 employees working to transform how people experience health care. Recognized as a Top 100 Healthiest Workplaces and among the World’s Most Ethical Companies, we are rooted in a legacy that puts people first, always. They are dedicated to making the healthcare experience simpler, better, and more affordable for people and their families, including the 3.3 million people they serve through their regional health plans. They are deeply rooted in a 100-year legacy of transforming the industry and how people experience health care. And they’re committed to delivering a seamless, personalized healthcare experience for the next 100 years. They have taken their legacy business and pivoted to meet the needs of today’s healthcare consumers. Health Insurance Claims Processor: Our client is seeking a Health Insurance Claims Processor to join a collaborative operations team responsible for ensuring the accurate and timely processing of healthcare claims. This role is ideal for a detail-oriented professional who thrives in a fast-paced environment, enjoys solving problems through research and analysis, and is committed to delivering exceptional service while maintaining quality and productivity standards. This role is fully remote. Applicants must reside in North Dakota, Oregon, Washington, Utah, or Idaho and must work Central Time Zone hours from 8AM-4:30PM.Health Insurance Claims Processor Responsibilities: Process healthcare claims accurately and efficiently by reviewing documentation, researching eligibility and benefit information, and applying contract guidelines across multiple claim types. Investigate and resolve claim discrepancies by analyzing available information, applying sound judgment, and ensuring accurate claim adjudication. Review, adjust, and reprocess previously adjudicated claims while maintaining thorough documentation and audit trails. Verify pricing, coordination of benefits, and other claim details as needed to support accurate payment decisions. Respond professionally to inquiries from members, providers, and internal business partners, providing clear explanations of claims-related processes. Meet established productivity, quality, accuracy, attendance, and turnaround time expectations in a high-volume production environment. Adapt quickly to changing procedures, benefit plans, processing systems, and departmental priorities while maintaining processing accuracy. Identify processing issues, system improvements, or documentation updates and communicate recommendations to appropriate stakeholders. Support inventory management, reporting, training, and other departmental projects as assigned. Maintain strict confidentiality and comply with organizational policies, procedures, and regulatory requirements. Health Insurance Claims Processor Qualifications: High school diploma or equivalent required. Two or more years of office experience, preferably in health insurance claims processing, medical billing, medical office operations, or a related administrative environment. Experience processing or researching healthcare claims and applying benefit or contract information is preferred. Strong computer proficiency, including Microsoft Office applications such as Outlook, Word, and Excel. Excellent keyboarding, data entry, and basic math skills with exceptional attention to detail. Demonstrated ability to analyze information, exercise sound judgment, and resolve moderately complex claims-related issues. Strong written and verbal communication skills with a customer-focused approach. Ability to manage multiple priorities, work independently, and collaborate effectively within a team environment. Proven ability to quickly learn new systems, policies, procedures, and claims processing guidelines. Ability to thrive in a fast-paced, high-volume environment while consistently meeting quality and production goals. Willingness to work possible overtime or occasional travel as business needs require.