Health Claims Specialists- Remote

Company Description

About Sutherland

Artificial Intelligence. Automation.Cloud engineering. Advanced analytics.For business leaders, these are key factors of success. For us, they’re our core expertise.
We work with iconic brands worldwide. We bring them a unique value proposition through market-leading technology and business process excellence.

We’ve created over 200 unique inventions under several patents across AI and other critical technologies. Leveraging our advanced products and platforms, we drive digital transformation, optimize critical business operations, reinvent experiences, and pioneer new solutions, all provided through a seamless “as a service” model.

For each company, we provide new keys for their businesses, the people they work with, and the customers they serve. We tailor proven and rapid formulas, to fit their unique DNA.We bring together human expertise and artificial intelligence to develop digital chemistry. This unlocks new possibilities, transformative outcomes and enduring relationships.

Sutherland
Unlocking digital performance. Delivering measurable results.

Job Description

This is a full-time permanent healthcare claims adjudicator position. A claims adjudicator determines how much money will be paid after an insurance claim has been examined. This is not a customer service or customer facing position. This is a data entry position where you will be processing medical claims per the specific client requirements. Claims can vary and are highly customized depending on the service level. You will work independently with the assistance of knowledge base and support personnel. You will also be expected to meet all Key Performance Indicators and Quality goals throughout Training and beyond.

What you will be doing as a Claims Examiner:

• Work independently, processing claims via data entry for 90% of your day.
• Be responsible for effectively adjudicating claims to meet production, quality, and other metrics in accordance with policy/procedures and regulatory guidelines
•  Follow up on claims needing additional information
•  Refer problem claims to a Lead and/or auditor for additional review
•  Make sure that the integrity of the information is accurate and kept private according to HIPPA guidelines
•  Work with specific software
•  May be assigned special projects

We offer:

• Salary of $13.50/hour + monthly incentives up to $1500/month
• Monthly rewards & recognition programs
• Medical, dental and vision benefits
• Paid training & PTO
• Cross program and advancement opportunities – 80% of our frontline leaders have been promoted from within
• Employee Discounts
• EAP & Health and Wellness programs including a personal trainer dedicated to Sutherland

Qualifications

• Health or health insurance claims experience
• Knowledge of medical terminology
• Some experience in a medical office
• Accurate typing of 40 WPM

We will provide equipment, however to work from home, you must have:

• Excellent Internet connectivity:
  • Internet access speeds of 2 Mbps upload and 10 Mbps download – the faster the better!
  • In-house network, and a hard-wired Internet connection capable of continuously supporting outstanding call quality and high-speed response rates. (wireless and/or satellite Internet Service Providers are not compatible with our systems)
• A quiet and distraction-free, secure place to work.

IMPORTANT NOTE: This job is open only to residents of the United States, and you must be authorized to work in the US in order to be considered for employment.

Additional Information

About Us

Sutherland, recently recognized as a Great Place to Work in the US, is a digital transformation company, making digital processes feel more human for the customers that we serve. We have been helping customers globally, across industries from financial services to healthcare, entertainment to retail, insurance to gaming, and everything in between, provide exceptional experiences for their customers for over 35 years.

EEOC and Veteran Documentation
During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.
At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all 
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.

#SP

EEOC and Veteran Documentation
During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.
At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all 
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.