[Hiring] Medicare Account Resolution Specialist @Sarnova

Role Description

Digitech is seeking a highly motivated and detail‑oriented Insurance Account Resolution Specialist to manage and resolve insurance claims after submission to commercial insurance carriers. This role is responsible for ensuring timely, accurate, and compliant claim resolution by reviewing pending, denied, or incorrectly paid claims and following through until payment is secured. Success in this role requires strong analytical skills, excellent follow‑through, and the ability to manage a high‑volume workload in a fast‑paced environment.

• Research and resolve outstanding insurance claims, including those that are pending, unable to be released, denied, or paid incorrectly by commercial insurance carriers.
• Investigate claims placed on hold, identifying root causes, correcting errors, and executing needed follow‑up actions to release claims for processing.
• Analyze insurance denials, determining denial reasons, assessing validity, and completing the appropriate resolution steps such as appeals, corrections, or resubmissions.
• Communicate directly with insurance carriers via outbound calls to obtain claim status, clarify discrepancies, and secure detailed explanations for pending or denied claims.
• Prepare and submit additional documentation requested by insurance carriers to support claim adjudication and ensure accurate processing.
• Draft and submit appeals when necessary, ensuring they are supported by proper documentation, regulatory guidelines, and payer‑specific requirements.
• Process and manage incoming correspondence, including mail, emails, EOBs, requests for information, and any necessary refunds.
• Maintain accurate, detailed notes in billing systems for all follow‑up activities, findings, and next steps.
• Identify trends or recurring issues, escalating concerns to supervisors or appropriate internal teams to support process improvement.
• Meet daily productivity and accuracy expectations, contributing to a high‑performing team environment.
• Additional job duties as assigned.

Qualifications

• Education: High School Diploma or equivalent required.
• Strong computer skills, including working knowledge of MS Outlook, Word, and Excel.
• Ability to type 40 WPM with accuracy.
• Proven ability to handle high‑volume workloads, prioritize effectively, and meet tight deadlines.
• Experience in a structured environment where call monitoring, performance metrics, or productivity scoring are used is helpful.
• Strong verbal communication skills with the ability to remain calm, professional, and effective during phone interactions with insurance carriers.
• Excellent written communication skills for crafting clear, accurate documentation and correspondence.
• Exceptional attention to detail and accuracy in reviewing claims, identifying discrepancies, and documenting findings.
• Highly organized, self‑paced, and capable of managing work independently in a remote environment.
• Dependable, punctual, and accountable, with a willingness to ask questions and seek clarification when needed.
• Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment.

Requirements

• Ability to talk, hear, and see clearly to read and interpret information.
• Regular use of a computer, phone, and standard office equipment.
• May be required to travel for business purposes.
• Ability to secure confidential information.
• Perform all duties in a professional environment free of noise or anything that would create a negative customer experience.

Benefits

• Competitive salary, commensurate with experience.
• Comprehensive benefits package, including 401(k) Plan.