Remote Claims & Insurance Customer Service Representative – Detailed Medical Claims Processing & Support at careerzynith
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About careerzynith – Leading the Future of Insurance Services
At careerzynith, we are redefining how insurance and healthcare intersect by delivering fast, accurate, and compassionate claims support to millions of policyholders across the nation. Our remote‑first philosophy empowers talented professionals to work from anywhere while contributing to a mission‑driven organization that values integrity, innovation, and continuous learning. As a rapidly growing leader in the claims processing space, careerzynith invests heavily in technology, training, and employee well‑being, ensuring every team member has the tools and support needed to excel.
Position Overview
We are seeking a highly detail‑oriented Remote Claims & Insurance Customer Service Representative to join our dynamic call‑center team. In this role, you will be the primary point of contact for claimants, healthcare providers, and internal stakeholders, handling inbound and outbound communications, reviewing medical claims for accuracy, and applying industry‑standard coding and regulations. This is a full‑time, work‑from‑home opportunity that offers a competitive hourly rate, a supportive culture, and clear pathways for career advancement within careerzynith.
Key Responsibilities
Customer Interaction & Communication
Provide courteous, professional, and timely inbound and outbound support to claimants, providers, and internal teams.
Explain claim status, coverage details, and next steps in a clear, empathetic manner.
Document all interactions accurately in the claims management system.
Claims Review & Processing
Review and validate health insurance claims for completeness, accuracy, and compliance with policy guidelines.
Utilize financial software to calculate claim amounts, apply deductibles, and determine payable amounts.
Apply ICD‑9 (and emerging ICD‑10) coding standards to ensure proper medical classification.
Maintain and organize medical records, supporting documentation, and claim files in accordance with regulatory requirements.
Regulatory & Compliance Assurance
Interpret and apply Workers’ Compensation laws, state insurance regulations, and internal policies to each claim.
Verify insurance coverage and eligibility, flagging any discrepancies for further investigation.
Collaborate with the medical billing team to resolve coding issues, missing documentation, or payment disputes.
Data Management & Reporting
Leverage advanced Microsoft Excel functions (pivot tables, VLOOKUP, conditional formatting) to generate daily, weekly, and monthly reports.
Identify trends, anomalies, and opportunities for process improvement based on data analysis.
Assist the analytics team in developing dashboards that track key performance indicators (KPIs) such as claim turnaround time and accuracy rates.
Essential Qualifications
Experience: Minimum 1 year of experience in a call‑center environment, preferably within insurance, healthcare, or medical billing.
Technical Proficiency: Demonstrated ability to navigate financial software and Microsoft Excel; comfort with data entry and spreadsheet manipulation.
Regulatory Knowledge: Familiarity with Workers’ Compensation statutes and basic health insurance terminology.
Communication Skills: Excellent verbal and written communication, with a proven track record of delivering clear information to diverse audiences.
Attention to Detail: Strong focus on accuracy when reviewing claims, coding, and documentation.
Education: High school diploma or equivalent; additional coursework in health administration, business, or related fields is a plus.
Preferred Qualifications
Experience with ICD‑9/ICD‑10 coding and medical terminology.
Prior exposure to workers’ compensation claims processing.
Certification in claims handling (e.g., CPC, AAPC) or enrollment in a related certification program.
Advanced Excel skills, including macro creation or basic VBA scripting.
Demonstrated ability to work independently in a remote setting while maintaining high productivity.
Core Skills & Competencies
Analytical Thinking: Ability to dissect complex claim scenarios, identify root causes, and recommend corrective actions.
Customer‑Centric Mindset: Commitment to delivering a positive experience for claimants, even in challenging situations.
Time Management: Efficiently prioritize tasks to meet service level agreements (SLAs) and daily volume targets.
Team Collaboration: Work closely with medical billing, underwriting, and compliance teams to ensure seamless claim resolution.
Technology Adaptability: Quick learner of new software platforms, claim management tools, and emerging industry technologies.
Career Growth & Learning Opportunities
careerzynith believes that employee development is a cornerstone of organizational success. As a Claims & Insurance Customer Service Representative, you will have access to:
Structured onboarding and mentorship programs that pair you with seasoned claims professionals.
Continuous learning portals offering courses on advanced coding, regulatory updates, and customer service excellence.
Clear career pathways to roles such as Senior Claims Analyst, Claims Supervisor, or Remote Operations Manager.
Opportunities to participate in cross‑functional projects, including process automation initiatives and quality‑improvement task forces.
Compensation, Perks & Benefits
While the exact compensation package may vary based on experience, careerzynith offers a competitive hourly wage starting at $13.50 per hour, with performance‑based incentives and potential for wage growth. Additional benefits include:
Fully remote work arrangement – no commute, flexible home office setup.
Standard 40‑hour work week with an 8‑hour shift schedule, Monday through Friday.
Paid time off, holidays, and sick leave.
Access to health, dental, and vision insurance plans (eligibility after a probationary period).
Retirement savings options with company matching contributions.
Employee assistance program (EAP) for mental health and wellness support.
Technology stipend to equip your home office with a reliable computer, headset, and high‑speed internet.
Work Environment & Culture at careerzynith
At careerzynith, we foster a collaborative, inclusive, and high‑performance culture that celebrates diversity of thought and background. Our remote teams stay connected through regular virtual huddles, team‑building activities, and an open‑door policy with leadership. We prioritize:
Transparency: Clear communication of goals, expectations, and company updates.
Recognition: Frequent acknowledgment of individual and team achievements through awards, shout‑outs, and bonus programs.
Innovation: Encouragement to suggest process improvements, adopt new tools, and experiment with automation.
Work‑Life Balance: Flexible scheduling options and a supportive environment that respects personal commitments.
Application Process
If you are passionate about delivering accurate, compassionate claims support and thrive in a remote, fast‑paced environment, we want to hear from you. To apply, click the link below, submit your resume, and tell us why you would be a perfect fit for the careerzynith team.
Apply Job!
Join careerzynith – Make an Impact Every Day
At careerzynith, your work directly influences the financial well‑being of individuals and families navigating complex medical and insurance landscapes. By ensuring claims are processed accurately and efficiently, you help people receive the care they need without unnecessary delays. Become part of a forward‑thinking organization where your contributions are valued, your growth is supported, and your career can flourish. Apply today and start your journey with careerzynith!
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Apply for this job
About careerzynith – Leading the Future of Insurance Services
At careerzynith, we are redefining how insurance and healthcare intersect by delivering fast, accurate, and compassionate claims support to millions of policyholders across the nation. Our remote‑first philosophy empowers talented professionals to work from anywhere while contributing to a mission‑driven organization that values integrity, innovation, and continuous learning. As a rapidly growing leader in the claims processing space, careerzynith invests heavily in technology, training, and employee well‑being, ensuring every team member has the tools and support needed to excel.
Position Overview
We are seeking a highly detail‑oriented Remote Claims & Insurance Customer Service Representative to join our dynamic call‑center team. In this role, you will be the primary point of contact for claimants, healthcare providers, and internal stakeholders, handling inbound and outbound communications, reviewing medical claims for accuracy, and applying industry‑standard coding and regulations. This is a full‑time, work‑from‑home opportunity that offers a competitive hourly rate, a supportive culture, and clear pathways for career advancement within careerzynith.
Key Responsibilities
Customer Interaction & Communication
Provide courteous, professional, and timely inbound and outbound support to claimants, providers, and internal teams.
Explain claim status, coverage details, and next steps in a clear, empathetic manner.
Document all interactions accurately in the claims management system.
Claims Review & Processing
Review and validate health insurance claims for completeness, accuracy, and compliance with policy guidelines.
Utilize financial software to calculate claim amounts, apply deductibles, and determine payable amounts.
Apply ICD‑9 (and emerging ICD‑10) coding standards to ensure proper medical classification.
Maintain and organize medical records, supporting documentation, and claim files in accordance with regulatory requirements.
Regulatory & Compliance Assurance
Interpret and apply Workers’ Compensation laws, state insurance regulations, and internal policies to each claim.
Verify insurance coverage and eligibility, flagging any discrepancies for further investigation.
Collaborate with the medical billing team to resolve coding issues, missing documentation, or payment disputes.
Data Management & Reporting
Leverage advanced Microsoft Excel functions (pivot tables, VLOOKUP, conditional formatting) to generate daily, weekly, and monthly reports.
Identify trends, anomalies, and opportunities for process improvement based on data analysis.
Assist the analytics team in developing dashboards that track key performance indicators (KPIs) such as claim turnaround time and accuracy rates.
Essential Qualifications
Experience: Minimum 1 year of experience in a call‑center environment, preferably within insurance, healthcare, or medical billing.
Technical Proficiency: Demonstrated ability to navigate financial software and Microsoft Excel; comfort with data entry and spreadsheet manipulation.
Regulatory Knowledge: Familiarity with Workers’ Compensation statutes and basic health insurance terminology.
Communication Skills: Excellent verbal and written communication, with a proven track record of delivering clear information to diverse audiences.
Attention to Detail: Strong focus on accuracy when reviewing claims, coding, and documentation.
Education: High school diploma or equivalent; additional coursework in health administration, business, or related fields is a plus.
Preferred Qualifications
Experience with ICD‑9/ICD‑10 coding and medical terminology.
Prior exposure to workers’ compensation claims processing.
Certification in claims handling (e.g., CPC, AAPC) or enrollment in a related certification program.
Advanced Excel skills, including macro creation or basic VBA scripting.
Demonstrated ability to work independently in a remote setting while maintaining high productivity.
Core Skills & Competencies
Analytical Thinking: Ability to dissect complex claim scenarios, identify root causes, and recommend corrective actions.
Customer‑Centric Mindset: Commitment to delivering a positive experience for claimants, even in challenging situations.
Time Management: Efficiently prioritize tasks to meet service level agreements (SLAs) and daily volume targets.
Team Collaboration: Work closely with medical billing, underwriting, and compliance teams to ensure seamless claim resolution.
Technology Adaptability: Quick learner of new software platforms, claim management tools, and emerging industry technologies.
Career Growth & Learning Opportunities
careerzynith believes that employee development is a cornerstone of organizational success. As a Claims & Insurance Customer Service Representative, you will have access to:
Structured onboarding and mentorship programs that pair you with seasoned claims professionals.
Continuous learning portals offering courses on advanced coding, regulatory updates, and customer service excellence.
Clear career pathways to roles such as Senior Claims Analyst, Claims Supervisor, or Remote Operations Manager.
Opportunities to participate in cross‑functional projects, including process automation initiatives and quality‑improvement task forces.
Compensation, Perks & Benefits
While the exact compensation package may vary based on experience, careerzynith offers a competitive hourly wage starting at $13.50 per hour, with performance‑based incentives and potential for wage growth. Additional benefits include:
Fully remote work arrangement – no commute, flexible home office setup.
Standard 40‑hour work week with an 8‑hour shift schedule, Monday through Friday.
Paid time off, holidays, and sick leave.
Access to health, dental, and vision insurance plans (eligibility after a probationary period).
Retirement savings options with company matching contributions.
Employee assistance program (EAP) for mental health and wellness support.
Technology stipend to equip your home office with a reliable computer, headset, and high‑speed internet.
Work Environment & Culture at careerzynith
At careerzynith, we foster a collaborative, inclusive, and high‑performance culture that celebrates diversity of thought and background. Our remote teams stay connected through regular virtual huddles, team‑building activities, and an open‑door policy with leadership. We prioritize:
Transparency: Clear communication of goals, expectations, and company updates.
Recognition: Frequent acknowledgment of individual and team achievements through awards, shout‑outs, and bonus programs.
Innovation: Encouragement to suggest process improvements, adopt new tools, and experiment with automation.
Work‑Life Balance: Flexible scheduling options and a supportive environment that respects personal commitments.
Application Process
If you are passionate about delivering accurate, compassionate claims support and thrive in a remote, fast‑paced environment, we want to hear from you. To apply, click the link below, submit your resume, and tell us why you would be a perfect fit for the careerzynith team.
Apply Job!
Join careerzynith – Make an Impact Every Day
At careerzynith, your work directly influences the financial well‑being of individuals and families navigating complex medical and insurance landscapes. By ensuring claims are processed accurately and efficiently, you help people receive the care they need without unnecessary delays. Become part of a forward‑thinking organization where your contributions are valued, your growth is supported, and your career can flourish. Apply today and start your journey with careerzynith!
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Apply for this job