Medicare Claims Processing

February 14, 2026

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We welcome applications for our Claims Specialist positions at any time. If we do not have any current openings, we will keep applications on file and review them regularly. If your background is a strong match, we’ll reach out to set up an interview. Position Title: Claims / Encounter Specialist *Remote* Reports To: BPaaS Operations Manager/Director Position Summary: The Claims / Encounter Specialist will be required to perform reviews of pended claims of all types and specialties, apply business rules and finalize claims in accordance with regulatory and client expectations. Additionally, the specialist will review adjustment requests and determine whether to uphold the original decision or perform an adjustment of the claim to correct outcomes. This role will also be required to assist with review and preparation of claims data for submission of encounters. The specialist must have excellent analytical skills, along with keen attention to detail and good written and oral communication abilities. Responsibilities: <ul> <li>Perform timely and accurate claim adjudication and adjustments</li> <li>Adjudicate specialty claims, including, but not limited to ambulatory surgery, skilled nursing, dental, anesthesia, medical assistance, reprocessed claims, duplicate claims, ambulance, durable medical equipment (DME), or institutional based charges.</li> <li>Prepare encounters for submission and correct rejected encounters</li> <li>Support system inquiries documented from the member and provider call center services</li> <li>Research and review Claims Appeals information to support client inquiries</li> <li>Meet established production and quality standards</li> <li>Identify opportunities to improve efficiency within assigned processes</li> </ul> Minimum Requirements Industry Experience <ul> <li>1-3 years in healthcare industry experience working in the payer segment in Medicare Advantage, Managed Medicaid, or working with an industry competitor. </li> <li>Experience in BPaaS environment is a plus.</li> </ul> Skills & Knowledge <ul> <li>Candidate should have experience working in a production environment and the ability to meet performance standards. Attention to detail and the ability to apply documented procedures to achieve desired outcomes are also required. MS Word and MS Excel, good interpersonal skills, written and oral communication abilities a must. </li> </ul> Years of Experience <ul> <li>1-3 years</li> </ul> Education <ul> <li>A High School Diploma is required.</li> </ul> Compensation and Benefits <ul> <li>Competitive hourly rate commensurate with experience</li> <li>100% remote work culture</li> <li>Health, dental & vision insurance</li> <li>Vacation and holiday pay</li> <li>Traditional and ROTH 401k with company match</li> <li>Company paid life insurance, AD&D, and long-term disability coverage</li> <li>HSA and FSA accounts</li> <li>Tuition Reimbursement</li> <li>Parental Leave </li> </ul> Compliance: All employees shall comply with company policies, including those related to security and privacy, as well as with applicable laws and regulations such as the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, and other relevant federal and state regulations. Data Protection: Employees are responsible for safeguarding protected health information (PHI) and personally identifiable information (PII) in accordance with company policies and HIPAA regulations. This includes ensuring that all data is accessed, processed, stored, and transmitted securely.

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

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When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

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4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

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Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

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The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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