Claims Processor

About the Company

Health Admins is working to become a leading technology-enabled healthcare administration platform. Its mission centers on steady improvement and on delivering efficient, innovative solutions that improve the experience for members and clients. The company is looking for a seasoned Claims Processor who brings discipline, a service mindset, and a commitment to ongoing progress.

Role Overview

This position is ideal for someone detail-oriented, research-driven, and strongly service-focused. The Claims Processor will handle medical claim activity, support audit and compliance efforts, and help ensure accurate, timely, and professional service for clients, members, and providers.

Work Location and Employment Type

This is a full-time, non-exempt remote position. Texas is preferred for the location.

Core Values

• Take ownership of work and outcomes.
• Maintain professional discipline in daily work.
• Embrace change as a way to improve.
• Treat service as a privilege.

The team is expected to live these principles and approach decision-making and problem-solving with the mindset of being “a hero in action.”

Key Duties

• Handle submitted medical claims accurately and within expected timelines.
• Check claim details for completeness and correctness, including patient information, diagnosis codes, procedure codes, and billing codes when available.
• Apply insurance policy rules and industry requirements to claim review.
• Look into discrepancies, errors, and other claim-related issues and work toward resolution.
• Perform detailed audits of medical claims to uncover mistakes, mismatches, or suspicious activity.
• Review medical records and billing documents to confirm alignment with coding and reimbursement standards.
• Research complicated billing and coding questions to support processing and audit work.
• Interpret coding rules, reimbursement policies, and relevant legal requirements to determine claim outcomes.
• Suggest improvements to claim submission workflows and reimbursement accuracy.
• Act as the main contact for claim questions and resolutions from members.
• Reply to customer concerns quickly, professionally, and with empathy.
• Work closely with other teams to resolve issues and keep cases moving forward.

Required Background and Skills

• Strong understanding of medical terminology, coding, and insurance billing processes.
• Good analytical ability to work through healthcare rules and guidelines.
• High accuracy and strong attention to detail in documentation and data handling.
• Clear written and verbal communication with a customer-first approach.
• Ability to work both independently and with a team in a fast-moving, deadline-oriented setting.
• Strong interpersonal communication, active listening, and problem-solving skills.
• Self-driven attitude with the ability to take initiative.
• Solid time management and prioritization skills.
• Comfort with multitasking in a busy team environment.
• Ability to adapt quickly to change and reset priorities when needed.
• Experience with Salesforce, Google Workspace, and claims management software.

Education and Experience

• High school diploma or an equivalent qualification.
• Previous experience in medical claims processing and healthcare reimbursement.

What the Employer Offers

• Competitive compensation and benefits.
• A dynamic and innovative workplace.
• Opportunities to grow professionally.
• Remote work arrangement.

Equal Opportunity and Accommodation

The employer is committed to inclusion and equal opportunity. Hiring decisions are made without regard to race, color, religion, gender, gender identity or expression, family status, marital status, sexual orientation, national origin, genetics, neurodiversity, disability, age, veteran status, or any other protected characteristic. Reasonable accommodation is available for qualified individuals with disabilities during the application process.