Virtual Health Claims Processor

Vintti is a dynamic staffing agency bridging the gap between Latin American talent and US-based businesses. We specialize in connecting skilled professionals from Latin America with small and medium-sized businesses, startups, and firms across the United States. Our mission is to provide top-tier staffing solutions that enable US companies to access a diverse pool of talented individuals while offering exciting career opportunities to Latin American professionals. By leveraging our extensive network and deep understanding of both markets, Vintti facilitates mutually beneficial partnerships that drive growth and innovation for our clients and candidates alike.

The Virtual Health Claims Processor plays a crucial role in the healthcare industry by efficiently managing and processing health insurance claims in a remote environment. Utilizing advanced software and data management tools, this professional ensures accurate, timely adjudication of claims, minimizing errors and reducing payment delays. They collaborate with healthcare providers, insurance companies, and patients to verify information, resolve discrepancies, and facilitate smooth transactions. Their expertise helps maintain compliance with regulations, safeguard patient privacy, and ultimately contributes to the efficient functioning of healthcare financial operations.

- High school diploma or equivalent; associate or bachelor's degree preferred.
- At least 1-2 years of experience in health claims processing or a related field.
- Knowledge of health insurance policies, regulations, and compliance standards.
- Proficiency in medical coding standards, including ICD-10 and CPT.
- Strong analytical skills with attention to detail.
- Familiarity with claims processing software and databases.
- Excellent communication skills, both written and verbal.
- Ability to work independently and collaboratively in a remote environment.
- Strong organizational skills and ability to manage high volumes of claims.
- Critical thinking and problem-solving abilities.
- Commitment to maintaining confidentiality and HIPAA compliance.
- Ability to prioritize tasks and meet productivity targets.
- Strong computer proficiency, including Microsoft Office Suite.
- Ability to identify and flag suspicious or fraudulent claims.
- Willingness to participate in ongoing training and professional development.

- Process incoming health insurance claims from various providers.
- Verify and validate patient and provider information for accuracy.
- Analyze claim data and documentation for completeness and compliance.
- Communicate with healthcare providers and patients for additional information.
- Apply ICD-10 and CPT coding standards to claims.
- Adjudicate claims based on policy terms, coverage, and benefit schedules.
- Identify and flag fraudulent or suspicious claims.
- Maintain knowledge of insurance policies, regulations, and compliance requirements.
- Use claims processing software and databases for managing claims.
- Document claim decisions and actions taken.
- Respond to inquiries and provide updates on claim statuses.
- Collaborate with team members to address complex claim issues.
- Engage in ongoing training and professional development.
- Manage a high volume of claims to meet performance standards.
- Escalate unresolved issues to higher-level departments or management.

The ideal candidate for the Virtual Health Claims Processor role will possess a strong educational foundation, ideally with an associate or bachelor's degree, combined with at least 1-2 years of experience in health claims processing or a related field. They will be highly proficient in medical coding standards, including ICD-10 and CPT, and demonstrate deep knowledge of health insurance policies, regulations, and compliance requirements. This individual will excel in analytical thinking and attention to detail, ensuring meticulous review and processing of claims. They will be adept at using claims processing software and databases, and possess strong computer proficiency, particularly in Microsoft Office Suite. Excellent written and verbal communication skills will enable them to effectively interact with healthcare providers, patients, and team members. The ideal candidate will be proactive, self-motivated, and possess a high degree of integrity and ethics, ensuring confidentiality and HIPAA compliance. They will thrive in a remote work environment, showcasing strong organizational skills and the ability to manage high volumes of claims while meeting productivity targets. Moreover, they will have a customer-service orientation, a collaborative attitude, and the resilience to handle constructive feedback. Their keen attention to detail will allow them to identify and flag suspicious claims, contributing to the overall integrity of the claims process. Adaptable to changing policies and procedures, the ideal candidate will remain calm and composed under pressure, demonstrating reliability, dependability, and a willingness to engage in ongoing training and professional development.

- Review and process incoming health insurance claims from various providers.
- Verify and validate patient and provider information to ensure accuracy.
- Analyze claim data and documentation for completeness and compliance with policy terms.
- Communicate with healthcare providers and patients to obtain missing information or clarify discrepancies.
- Apply coding standards, such as ICD-10 and CPT, to ensure proper claim submission.
- Adjudicate claims based on policy terms, coverage, and benefit schedules.
- Identify and flag fraudulent or suspicious claims for further investigation.
- Maintain up-to-date knowledge of insurance policies, industry regulations, and compliance requirements.
- Utilize claims processing software and databases to manage and track claims throughout the review process.
- Document claim decisions and actions taken in the processing system.
- Respond to inquiries and provide updates on claim statuses to policyholders and providers.
- Work collaboratively with team members to resolve complex claim issues.
- Participate in ongoing training and professional development to stay current with industry changes.
- Prioritize and manage a high volume of claims to meet performance and productivity standards.
- Escalate unresolved issues to higher-level departments or management as necessary.

- Detail-oriented with a strong focus on accuracy
- Excellent communication and interpersonal skills
- Strong analytical and problem-solving capabilities
- High degree of integrity and ethics
- Proactive and self-motivated
- Customer-service oriented
- Ability to work efficiently in a fast-paced environment
- Adaptable to changing policies and procedures
- Dependable and reliable
- Strong organizational skills
- Team player with a collaborative attitude
- Technology savvy with the ability to quickly learn new software systems
- Calm and composed under pressure
- Resilient and able to handle constructive feedback
- Keen attention to detail with the ability to spot inconsistencies and errors

- Competitive salary range
- Comprehensive health insurance (medical, dental, vision)
- Paid time off (PTO) and holidays
- Flexible work hours
- Remote work opportunities
- Retirement savings plan with company match
- Professional development and continuing education opportunities
- Performance bonuses and incentives
- Wellness programs and resources
- Employee assistance programs (EAPs)
- Life and disability insurance
- Career advancement opportunities
- Tuition reimbursement programs
- Employee recognition programs
- Work-life balance initiatives