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Sagility logo
Sagility

S.O.A.R With Sagility

Claims Processor

Claims SpecialistClaims SpecialistOtherRemoteJuniorTeam 10,001+H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

122 days ago

Salary

$17 / hour

Seniority

Junior

High School1 yr expExperience acceptedEnglish

Job Description

Claims Processor

Sagility

• 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

Job Requirements

  • 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
  • High School Diploma or equivalent.

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.

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