Full-Time Claims Processor

About the Role: We are seeking a Claims & Appeals Specialist with strong experience in facility-level claims, preferably from the payer side. This individual will manage appeals, resolve claims issues (including PENS), and communicate with providers and internal stakeholders. The role involves roughly 2 hours of daily phone work, with the remainder of the day focused on appeals and claims resolution. This is a hybrid role with the potential to become fully remote.

Required Skills:

• Facility claims and appeals processing experience
• Strong knowledge of Medicare and Medicaid claims
• Excellent phone communication skills and comfort working with providers
• Ability to work independently and make appeal decisions
• Experience collaborating with auditors, nurses, and physicians

Preferred Skills:

• Experience with PCM claims software (highly preferred)
• Familiarity with BRG coding and hospital claim workflows
• Background working with claims that fall out of systems (PENS)
• Previous call center experience (for contract-to-hire track)

What is the last date for applying to the job?

Which countries are accepted for this remote job?