REMOTE Medical Claims Representative

Remote Customer Service Representative - Medical Claims (Contract to Hire) Preferred Time Zones: Mountain or Pacific. Candidates in Central or Eastern Time Zone must have experience working a later shift.ScheduleMonday‐Friday: 8:30 AM – 5:00 PM Pacific Time or 9:30 AM – 6:00 PM Mountain TimeCandidates in CST/EST must be comfortable working 11:30 AM – 8:00 PM ESTPosition Overview The Remote Customer Service Representative (CSR) provides timely, accurate, and customer‐focused benefit and claim support for a variety of supplemental health insurance products, including SB Medical, Accident, Critical Illness, Hospital Indemnity, Prescription, Dental, Vision, and MEC plans. This role is heavily focused on claims intake and customer support, requiring strong medical claims knowledge, high attention to detail, and the ability to manage a high call volume in a remote call‐centre environment.Key ResponsibilitiesCustomer Service & Call Handling (80%)Handle an average of 40‐50 inbound customer service calls per day.Provide clear, accurate information regarding benefits, claims status, and coverage.Collect and enter all required claim information accurately and efficiently.Document detailed call summaries in the claims system ensuring clarity and accuracy.Issue timely and accurate claim acknowledgement correspondence.Process incoming documentation with high coding integrity and route appropriately.Claims Registration (15%)Accurately register and enter incoming medical claims.Meet or exceed productivity and quality metrics.Process approximately 20 claims per day.Additional Duties (5%)Perform other tasks or projects as assigned by management.Required Qualifications (Must Haves)1‐2+ years of experience working with health insurance claims and benefits, specifically scheduled accident, critical illness, and hospital indemnity.Medical claims processing experience involving doctor visits, diagnostic testing, and hospital stays.Strong knowledge of CPT, HCPCS, Revenue Codes, and ICD10.Hands‐on experience reading and interpreting HCFA 1500 and UB04 forms.Ability to review and understand medical records and Explanation of Benefits (EOBs).1+ year of call centre experience (remote experience strongly preferred).Comfortable working in a high‐volume, metric‐driven environment.Skills & KnowledgeMedical Claims ProcessingHealth Insurance & Supplemental BenefitsCustomer Service (Call Centre)Claims Intake & RegistrationMedical Billing & Revenue CycleAppeals & DenialsCPT / ICD10 CodingHCFA 1500 & UB04 FormsExperience Level Expert LevelJob Type & Location Contract to Hire, Remote position based out of Raleigh, NC; project based out of El Paso, TX.Pay and BenefitsPay range: $21.00 – $23.00 /hr.Benefits (temporary role) may include medical, dental & vision; critical illness, accident, and hospital; 401(k) Retirement Plan (pre‐tax and Roth); life insurance; short and long‐term disability; health spending account; transportation benefits; employee assistance program; time off/leave (PTO, vacation or sick leave). Eligibility and specific terms may vary by classification and length of employment.Workplace Type This is a fully remote position.Application Deadline This position is anticipated to close on April 30, 2026.Equal Employment Opportunity The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.#J-18808-Ljbffr