Sagility logo
Sagility

S.O.A.R With Sagility

Claims Processor - Work from Home

Location

United States

Posted

63 days ago

Salary

$17 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Claims Processor - Work from Home

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 someone who values open communication, connection, and teamwork, you will thrive in our environment where showing up authentically matters. 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. BroadPath, a Sagility Company, may conduct background checks, previous employment verifications, and education verifications, based on position requirements Diversity Statement At BroadPath, a Sagility Company, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation! Equal Employment Opportunity/Disability/Veterans If you need accommodation due to a disability, please email us at HR@Broad-path.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process BroadPath, a Sagility Company is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law. Compensation: BroadPath a Sagility Company has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Location: Work@Home USAUnited States of America

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Allstate logo

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Reserv logo

General Liability Claims Team Lead

Reserv

At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!

Full TimeRemoteTeam 201-500

About the role As a Team Lead at Reserv, you're not just managing from the sidelines—you're in the game. You'll support a Claims Manager or Claims Director while leading the New York Labor Law and Commercial General Liability adjusting team. But here's the best part: you stay hands-on. When your team needs you, you jump in and handle claims right alongside them. This is where your experience makes a real impact. You'll leverage cutting-edge technology and analytics to drive efficiencies, elevate performance, and reimagine what's possible in claims. You're a critical player for the team, the customers, and the client—balancing strategic leadership with rolling up your sleeves when volume demands it. Love fast-paced environments? Thrive on variety? Want to lead by example? If you believe great leadership means being in the trenches with your team, solving problems in real-time, and driving results that matter—this role was built for you. 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Allianz Insurance logo

Senior Claims Adjuster

Allianz Insurance

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us. At Allianz, we stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. And the foundation for this is our inclusive workplace, where people and performance both matter, and nurtures a culture grounded in integrity, fairness, inclusion and trust. We therefore welcome applications regardless of race, ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations. Join us. Let's care for tomorrow.

Full TimeRemoteTeam 5,001-10,000

Job Purpose: The main task of the role is to settle claims, in accordance with the segregation of duties principle. The Senior Claims Adjuster is responsible for processing claims received (settlement), managing a portfolio of claims and maintaining an appropriate service level. He/she denies, settles, or authorizes payments to routine claims based on coverage, appraisal, and verifiable information. Responsibilities also include corresponding with policyholders, brokers and agents and preparing report of findings of an investigation. Key Responsibilities: - Complete second level check of compliance with all policy terms and conditions utilizing commercial, risk and collection systems​ - Complete claim payment calculation by incorporating exclusions such as policy deductibles​ - Validate claim payment and loss settlement packages up to authority level of $225,000​ - Reject claim up to personal authority level of $270,000, with strong compliance with internal communication process to enhance customer experience ​ - Strong two-way communication with policyholders / brokers : request, if necessary, additional documents / information, provide updates on the status of the claim (assessed, settled), handle possible appeals (complaints)​ - Strong collaboration with Collections on disputed debts, to assess policyholders’ collection efforts and compliancy with obligations under policy, and to answer Collections requests/ authorizations​ - Close claims file following closing of Collections file - Handle objections to claims through negotiations with policyholders and any other stakeholders​ - Resolve claims issues which may have a major impact on claims settlements and business retention​ - Develop and maintain good relationships with policy holders and brokers by understanding their business and responding promptly to their questions​ - On a rotational basis take responsibility for the Claims Help Desk and in a timely manner respond to all enquiries received​ - Review payment plan submissions and approve up to authority level of $250,000 and 6 months​ - Review claim filing extensions up to authority level of $250,000 and 6 months - Key Experience: Market knowledge:​ - Knowledge of Claims and Collections processes and systems​ - Knowledge of Quality Standards , C&C operational guidelines​ - Ability to identify mandatory documents per type of claims / collection​ Required Skills​ - Strong interpersonal and communication skills - Comfortable with numbers; strong analytical skills - Strong attention to detail​ - Ability to determine the appropriate course of action in settling claims​ - Result oriented & Team player​ - Customer centric Key Skills: - Business expertise ​ - Strong knowledge of policies, contract law and local insolvency ​ - Strong knowledge of claims settlement processes and systems ​ - Strong knowledge of collections process​ - Strong knowledge of quality standards and claims and collection operational guidelines Key Requirements: - Bachelor’s Degree in Business Administration or a relevant field. - 5-10 years experience in claims settlement with insurance company​ - Excellent communication skills in English, both spoken and written - Must be liscensed - Looking for candidates that possess a basic awareness of Artificial Intelligence technologies and are enthusiastic about learning and integrating AI into everyday business processes. - - (Generative) Artificial Intelligence or GenAI or AIData Analysis(Microsoft) CopilotChatGPT - Data Analysis - (Microsoft) Copilot - ChatGPT Only meet some of the criteria? Please apply anyway – we want to hear from you! Total Compensation Range: $78,000-$90,000 Placement within the range provided above is based on the individual’s relevant experience, skills for the role, and location. Salary ranges are only one component of our total compensation package. Benefits: We value your goals and needs, at work and in life. As an associate, you’ll be supported with resources, benefits, and work-life balance so you can thrive in ways that matter to you. Featured employee benefits to enrich your life: · Competitive compensation · Annual bonus eligibility and/or commission structure opportunities · 401(k) discretionary match of up to 6% · Flexible work schedules · Health and wellness benefits · Paid time off for vacation, illness, Birthday Day Off and Volunteer Day Off · Tuition Reimbursement · Family care resources, including fertility and adoption benefits Learn more about our benefits here: https://rcmd-connect.com/allianztrade/ Our policies may change as our working lives evolve. Yet, our commitment to supporting our associates’ well-being and addressing the needs of our clients, business, and communities is unwavering. Commitment to Diversity, Equity, and Inclusion We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love, or what you believe in. We therefore welcome applications regardless of race, ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations. Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us. Note: Diversity of minds is an integral part of Allianz’ company culture. One means to achieve diverse teams is a regular rotation of Allianz Executive employees across functions, Allianz entities and geographies. Therefore, the company encourages its employees to have motivation in gaining varied skills from different positions and to collect experiences from across Allianz Group. Headquartered in Paris, Allianz Trade is the global leader in trade credit insurance and a recognized specialist in the areas of surety, collections, structured trade credit and political risk, present in over 40 countries with 5,800 employees. In 2024, our revenues reached 3.8 billion euros, and we guaranteed 1,400 billion euros of trade transactions worldwide. With sustainability, collaboration, and inclusion at the heart of our values, our workplace culture has earned global recognition — demonstrated by our certification as a Great Place to Work and a Gold Medal from EcoVadis in 2025.​ Disclaimer: Allianz Trade is the trademark used to designate a range of services provided by Euler Hermes. #LI-BB1 #LI-REMOTE

United States
$78K - $90K / year
Arkansas Blue Cross and Blue Shield logo

Claims Specialist

Arkansas Blue Cross and Blue Shield

We live here, work here and raise our families here – we are dedicated to Arkansas and to you.

Full TimeRemoteTeam 1,001-5,000Since 1948H1B No Sponsor

• Claims processing involves the actions required to pay or deny pended claims (those which did not auto-adjudicate), including: entering data into the system; reviewing and interpreting contract benefits; conducting edit and audit resolution; determining benefit eligibility; Identifying and researching processing issues through systems and manuals; routing claims to other areas; consulting internal staff and medical providers; generating correspondence; and completing forms to obtain necessary information. • Knowledge/Continuous Learning: In order to perform the actions required of the Claim Specialist job, the incumbent must undergo initial training, on-the-job training, and continuing education. Demonstrating knowledge of and possessing the ability to access all relevant computer systems and screens in order to process claims accurately; staying current with continually changing processing procedures, benefits, and system modifications; being knowledgeable of and able to meet corporate and national (MTM) standards while maintaining acceptable performance levels based on established departmental standards for productivity and quality; and showing familiarity with corporate and professional manuals and guidebooks, including the company processing manual and ICD, CPT, and HCPS codebooks. • Other duties: As assigned.

United States
Job Closed