Virtual Health Insurance 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.

A Virtual Health Insurance Claims Processor plays a crucial role in the healthcare industry by ensuring that insurance claims are accurately and efficiently handled. This remote position involves reviewing and verifying patient information, medical records, and insurance policy details to process claims swiftly. The role requires keen attention to detail to detect errors or inconsistencies and to ensure compliance with industry regulations. By liaising between healthcare providers and insurance companies, these processors help to expedite the reimbursement process, thereby facilitating timely payment for medical services rendered and supporting overall patient care management.

- High school diploma or equivalent.
- Proven experience in health insurance claims processing.
- Strong understanding of medical terminologies and billing codes.
- Proficiency with claims processing software and databases.
- Excellent attention to detail and accuracy.
- Strong analytical and problem-solving skills.
- Ability to manage and prioritize multiple tasks efficiently.
- Good written and verbal communication skills.
- Familiarity with health insurance policies and regulations.
- Ability to work independently and as part of a team.
- High level of integrity and confidentiality.
- Customer service experience or skills.
- Ability to handle sensitive and confidential information.
- Strong organizational and time management skills.
- Proficiency in Microsoft Office (Word, Excel, Outlook).
- Ability to identify and report irregularities or discrepancies in claims.
- Experience in remote work or virtual work environments preferred.
- Ability to adapt to new technologies and systems quickly.
- Willingness to undergo training and continuous learning.

- Review and process submitted health insurance claims.
- Verify patient eligibility and coverage details.
- Ensure completeness and accuracy of claim documentation.
- Analyze medical records and billing codes for claim validation.
- Communicate with healthcare providers for additional information or clarification.
- Input and update claim information in the database.
- Apply policy guidelines and coverage rules to claims.
- Identify and flag potential fraudulent claims.
- Resolve discrepancies in claims information or documentation.
- Adjudicate claims to approve or deny coverage.
- Collaborate with Customer Service and Underwriting for claim resolution.
- Generate and submit reports on processed claims.
- Maintain knowledge of insurance policies, procedures, and regulations.
- Respond to policyholders and providers regarding claim status or issues.
- Provide training and support to new team members.

The ideal candidate for the Virtual Health Insurance Claims Processor role is a highly meticulous and detail-oriented individual with proven experience in health insurance claims processing. They possess a strong understanding of medical terminology and billing codes, and are proficient with claims processing software and Microsoft Office. This critical thinker demonstrates exceptional analytical and problem-solving skills, with the ability to efficiently manage and prioritize multiple tasks. They have excellent written and verbal communication abilities, enabling effective interactions with healthcare providers and policyholders to resolve claim discrepancies and ensure accurate documentation. Familiarity with health insurance policies, procedures, and regulations is essential, as is a high level of integrity and confidentiality in handling sensitive information. The candidate thrives in both independent and collaborative work environments, especially in a virtual or remote setting. Their organizational and time management skills are top-notch, allowing them to adapt quickly to new technologies and systems. With a customer service-oriented mindset, they are proactive in identifying and resolving issues, demonstrate patience and professionalism under pressure, and are dedicated to continuous learning and skill development. Reliability, punctuality, and a commitment to accuracy further set this candidate apart as the perfect fit for the role.

- Review and process health insurance claims submitted by policyholders or healthcare providers.
- Verify patient eligibility and coverage details for submitted claims.
- Ensure all necessary documentation and information is complete and accurate for claim processing.
- Analyze medical records and billing codes to determine the appropriateness of the claim.
- Communicate with healthcare providers to obtain additional information or clarification on claims.
- Input and update claim information in the insurance company’s database.
- Apply appropriate policy guidelines and coverage rules to each claim.
- Identify and flag any potential fraudulent claims for further investigation.
- Resolve discrepancies or issues with claims information or documentation.
- Adjudicate claims to approve or deny coverage based on policy terms and conditions.
- Collaborate with other departments, such as Customer Service or Underwriting, for claim resolutions.
- Generate reports on processed claims and submit them to management for review.
- Maintain up-to-date knowledge of insurance policies, procedures, and regulatory requirements.
- Respond to inquiries from policyholders or providers regarding claim status or issues.
- Provide training and support to new claims processing team members as needed.

- Detail-oriented and meticulous
- Critical thinker with strong analytical skills
- Proficient in medical terminology and billing codes
- Effective communicator, both written and verbal
- Strong problem-solving capabilities
- Ability to work independently and collaboratively
- Highly organized with strong time management skills
- Adaptable to new technologies and systems
- Maintains high levels of integrity and confidentiality
- Proficient in claims processing software and Microsoft Office
- Able to prioritize and manage multiple tasks simultaneously
- Familiar with health insurance policies, procedures, and regulations
- Customer service-oriented
- Quick learner with a continuous improvement mindset
- Demonstrates patience and professionalism under pressure
- Experience with remote or virtual work environments
- Reliable and punctual
- High degree of accuracy and attention to detail
- Proactive in identifying and resolving discrepancies
- Willing to undergo training and continuous skill development

- Competitive salary range based on experience and qualifications
- Comprehensive health insurance (medical, dental, vision)
- Paid time off (PTO) including vacation, sick leave, and holidays
- Retirement savings plan with company match
- Flexible working hours with the option for remote work
- Opportunity for career advancement and professional growth
- Access to ongoing training and development programs
- Employee assistance program (EAP) for mental health and wellness support
- Company-sponsored certifications and continuing education opportunities
- Performance-based bonuses and incentives
- Subsidized gym membership or wellness programs
- Health and dependent care flexible spending accounts (FSAs)
- Life and disability insurance coverage policies
- Annual performance reviews with feedback and goal setting
- Employee discount programs and corporate perks
- Collaborative and supportive team environment
- Recognition and reward programs for outstanding performance
- Technology stipend for home office setup
- Parental leave and family support benefits
- Volunteer time off and community involvement opportunities