Evry Health
Evry Health2mo ago
USD 55000–60000/yr

Healthcare Claims Specialist - REMOTE

RemoteFull-Timemid
OperationsLegal & ComplianceHealthcareClaims Specialist
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Quick Summary

Overview

Responsible for the review and processing of claims within the claims transactional system, according to plan benefits and contractual reimbursement terms. Follows established policies and procedures to pay, pend for additional information, or deny claims.

Technical Tools
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  • Responsible for the review and processing of claims within the claims transactional system, according to plan benefits and contractual reimbursement terms.
  • Follows established policies and procedures to pay, pend for additional information, or deny claims.
  • Process claims subject to Coordination of Benefits (COB) according to plan benefits, COB rules and contractual reimbursement terms
  • Accountable to meet and maintain established department production and quality standards.
  • Create claim test cases, execute, and report on the results.
  • Identify and communicate defects or claim system issues to those responsible for configuration.
  • Work with configuration to remediate and retest defects.
  • Identify and communicate inventory issues to department’s management.
  • Works with internal departments, vendors, business partners, providers, etc. to help coordinate problem solving in an effective and timely manner.
  • Develop and maintain desk top procedures related to claim adjudication.
  • Audit auto-adjudicated and/or manually processed claims.
  • Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins.
  • You have a minimum of 3 years' medical claim adjudication/examination experience, working within a health insurance carrier, health insurance TPA, or equivalent.
  • You have knowledge of medical and insurance industry terminology including CPT/ICD-10, HCPCS and Revenue Codes.
  • You possess strong attention to detail and problem-solving skills with a high level of accuracy.
  • You have experience writing desk top procedures.
  • You are an excellent communicator, both verbally and in writing.
  • You can perform comfortably in a fast-paced, deadline-oriented work environment.
  • You are proficient in Microsoft Office applications Word, Excel, Outlook OneNote, etc.
  • You have prior experience using a CRM, preferably Salesforce.
  • You have prior experience with claim testing and or/auditing.
  • You collaborate and support business and operational units such as Customer Service, Medical Management and Appeals and Grievance.
  • Certified Coding Specialist (CCS) or Certified Coding Professional (CPC) preferred.
  • Bonus: Plexis/Quantum Choice experience.
  • Competitive salary
  • Comprehensive health, dental, and vision insurance as well as life and disability
  • Retirement savings plan with company match
  • Generous time off/vacation
  • Professional development opportunities
  • Flexible work environment
  • This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
  • Must live in the United States within the CST or EST time zones.
  • Company business hours are weekdays 9-5 CST.
  • Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
  • Ability to keep all company sensitive documents secure.
  • Must live in a location that receives an existing high-speed internet connection/service.
    •  

    Location & Eligibility

    Where is the job
    Worldwide
    Fully remote, anywhere in the world
    Who can apply
    Same as job location
    Listed under
    Worldwide

    Listing Details

    Posted
    March 4, 2026
    First seen
    April 2, 2026
    Last seen
    May 10, 2026

    Posting Health

    Days active
    37
    Repost count
    0
    Trust Level
    43%
    Scored at
    May 10, 2026

    Signal breakdown

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    Evry Health
    Evry Health
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    Employees
    30
    Founded
    2017
    Domain
    evryhealth.com
    Jobs
    View 4 jobs
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    Evry HealthHealthcare Claims Specialist - REMOTEUSD 55000–60000
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