Insurance Claims Specialist

Sutherland
Jamaica
Workplace: OnsiteFull timeFunction: Insurance & ActuarialExperience: 1+ yearsEducation: high_schoolSkills: ["Attention to detail","Analytical thinking","Critical thinking","Written communication","Verbal communication"]

Review, evaluate, and process medical insurance claims with high accuracy and professionalism. Enter claimant and policy data into claims systems, analyze supporting documents and medical records, and interpret clinical notes and diagnostic codes to determine eligibility. Ensure timely adjudication while meeting productivity and quality targets, document actions clearly, and collaborate with Quality Assurance, Customer Support, and Medical Review to resolve complex cases and escalate high-risk claims when needed.

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FursaFursa
Sutherland
Sutherland
3 days ago

Insurance Claims Specialist

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Canonical indexed version, validated from employer's careers page.

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 medical insurance claims with high accuracy and professionalism. Enter claimant and policy data into claims systems, analyze supporting documents and medical records, and interpret clinical notes and diagnostic codes to determine eligibility. Ensure timely adjudication while meeting productivity and quality targets, document actions clearly, and collaborate with Quality Assurance, Customer Support, and Medical Review to resolve complex cases and escalate high-risk claims when needed.
Location: Jamaica
Workplace: Onsite
Employment Type: Full time
Job Function: Insurance & Actuarial
Seniority: Entry level

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 as needed.
  • •Document claim actions in the system and collaborate with Quality Assurance, Customer Support, and Medical Review; escalate high-risk/unusual claims as appropriate.

Key Requirements

  • •Minimum of 4 CXC subjects including English A.
  • •1+ years of claims processing experience in medical claims entry, billing, or a related health care 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+ yearsHealthcareMedical insuranceClaims processing
Education:High School
Skills:Attention to detailAnalytical thinkingCritical thinkingWritten communicationVerbal communication
Languages:English
Tech Stack:Claims processing systemsMedical terminologyMicrosoft 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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