Medical Claims & Authorization Specialist

Location: Remote – South Africa

Employment Type: Full-Time

Working Hours: US Eastern Time (EST/EDT) Business Hours

Company: US-Based Healthcare Organisation

Overview

• We are recruiting on behalf of our client for a Medical Claims & Authorization Specialist to join a US-based healthcare organisation on a fully remote basis.
• The role focuses on managing medical insurance claims, following up on outstanding payments, resolving claim denials, handling appeals, and ensuring timely reimbursement from insurance providers.
• The successful candidate will have experience in medical billing, medical claims administration, or healthcare accounts receivable, with strong attention to detail and the ability to manage a high volume of accounts independently.
• Full training on the company's systems, processes, and specific insurance providers will be provided.

Key Responsibilities

• Follow up with insurance companies regarding unpaid, delayed, denied, and underpaid medical claims through telephone calls and online portals.
• Review rejected and denied claims, identify reasons for non-payment, correct discrepancies, and arrange resubmissions.
• Prepare and submit insurance appeals with the necessary supporting documentation.
• Monitor outstanding medical accounts and accounts receivable aging reports to ensure timely payment collection.
• Verify insurance information, claim statuses, and authorization details where required.
• Maintain accurate records of all claim activity, insurance communications, and account updates.
• Identify recurring billing issues, claim denials, and payment discrepancies, escalating them where necessary.
• Liaise with healthcare providers, clinics, and internal teams to obtain missing information and resolve outstanding claims.
• Ensure all claims, follow-ups, and appeals are handled within the required deadlines and insurance guidelines.

Requirements

• Matric (Grade 12) qualification as a minimum.
• Minimum 2 years of experience in medical billing, medical claims administration, healthcare accounts receivable, or a related field.
• Previous experience working with US medical insurance claims and billing processes is highly advantageous.
• Understanding of medical claims processing, insurance payments, rejected claims, and accounts follow-ups.
• Familiarity with medical coding terminology, including ICD-10, CPT, or HCPCS, is advantageous.
• Strong computer literacy, including Microsoft Excel or Google Sheets.
• Excellent written and verbal English communication skills.
• Ability to work independently, manage multiple accounts, and meet deadlines.
• Reliable home office setup with a stable internet connection.
• Availability to work US Eastern business hours.

Preferred Experience

• Experience working with US healthcare providers, medical billing companies, or healthcare outsourcing organizations.
• Knowledge of US insurance providers, including Medicare, Medicaid, Aetna, Cigna, and UnitedHealthcare.
• Experience using insurance portals such as Availity or similar platforms.
• Familiarity with Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), and insurance denial codes.
• Experience handling insurance appeals, claim resubmissions, and outstanding medical debtors.
• Exposure to medical billing software, practice management systems, or electronic health records (EHR).

Key Competencies

• Strong attention to detail and accuracy.
• Excellent organisational and time-management skills.
• Confident and professional telephone communication.
• Strong problem-solving and analytical abilities.
• Ability to manage high volumes of claims and accounts.
• Self-motivated, reliable, and capable of working independently.
• Willingness to learn new systems, processes, and US insurance requirements.
• Working Arrangements
• Fully remote position based in South Africa.
• Full-time employment aligned with US Eastern business hours.
• Opportunity to work with an established US healthcare organisation.
• Training provided on company-specific systems and processes.

Originally posted on Himalayas