Insurance Claims Specialist

Sutherland
Jamaica
Workplace: OnsiteFull timeFunction: Insurance & ActuarialExperience: 1+ yearsEducation: high_schoolSkills: ["Accuracy","Analytical thinking","Critical thinking","Communication","Organization"]

Review, evaluate, and process insurance claims with accuracy and professionalism. Enter claimant insurance data into claims systems, analyze medical records and supporting documents to determine eligibility, and resolve discrepancies by following up with providers, employers, or claimants. Ensure timely adjudication, document actions clearly, and collaborate with Quality Assurance, Customer Support, and Medical Review to escalate and handle complex or high-risk cases.

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FursaFursa
Sutherland
Sutherland
3 days ago

Insurance Claims Specialist

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Source: Company careers pageValidated by: Fursa AI
Last checked: 10 hours agoStatus: Live
Reposted: similar role first listed 2 months ago

Job Summary

Review, evaluate, and process insurance claims with accuracy and professionalism. Enter claimant insurance data into claims systems, analyze medical records and supporting documents to determine eligibility, and resolve discrepancies by following up with providers, employers, or claimants. Ensure timely adjudication, document actions clearly, and collaborate with Quality Assurance, Customer Support, and Medical Review to escalate and handle complex or high-risk cases.
Location: Jamaica
Workplace: Onsite
Employment Type: Full time
Job Function: Insurance & Actuarial

Key Responsibilities

  • •Review and process incoming claims according to company policies, guidelines, and regulatory requirements.
  • •Accurately enter claimant insurance data into claims processing systems.
  • •Analyze claim information, supporting documents, and medical records to determine accuracy and eligibility.
  • •Identify discrepancies or missing information and follow up with providers, employers, or claimants.
  • •Document all claim actions in the system, collaborate with internal teams, and escalate high-risk or unusual claims as needed.

Key Requirements

  • •High school diploma or equivalent; associate degree or certification in medical billing is a plus.
  • •Minimum 1+ years of claims processing experience in medical claims entry, billing, or a related healthcare administrative role.
  • •Familiarity with medical terminology and comfort reviewing medical records or clinical documentation.
  • •Familiarity with the U.S. healthcare system, insurance terminology, and claims processing.
  • •Strong analytical/critical-thinking skills with high attention to detail, plus excellent written and verbal communication.
Experience:1+ yearsHealthcareInsuranceMedical claims
Education:High School in Medical billing
Skills:AccuracyAnalytical thinkingCritical thinkingCommunicationOrganization
Languages:English
Tech Stack:Claims processing systemsMedical recordsDiagnostic codesMicrosoft Office

Company Brief

Sutherland
Global digital transformation and business process services firm offering AI, automation, cloud engineering, analytics and customer experience solutions to enterprises across industries.
Industry: Professional Services
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Established Company
Funding: Private Equity Backed
Headquarters: Pittsford (Rochester), NY, United States
Founded: 1986
Glassdoor
Glassdoor: 3.5
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