[Hiring] Claims Processor @Sagility

Role 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.
• Ensuring all claim processing aligns with CMS guidelines and client-specific policies and procedures.

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

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.

Requirements

• 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.

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.