Claims Processor - Work from Home

Job title
Claims Processor - Work from Home

About Sagility

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members.

The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics.

Sagility has more than 25,000 employees across 5 countries.

Job title:

Claims Processor - Work from Home

Job Description:

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.

Schedules, pay rates, and program details may vary based on business needs and client assignment.

Compensation Highlights


* Base Pay: Starting at $17 per hour


* Pay frequency: Weekly pay

Schedule Highlights


* Schedules can fall between the hours of Monday-Friday, 8:00 AM - 10:00 PM Eastern Time, and will be assigned based on business needs

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

At BroadPath, a Sagility Company, we believe that transparency, authenticity, and collaboration are the keys to building strong, connected remote teams.

Being on camera is an integral part of our culture.

It is how we build relationships, share ideas, and stay engaged.

If you are some...