Key Responsibilities

• Review medical insurance claims for accuracy, completeness, and compliance with policy guidelines
• Analyze medical records, policy documents, accident reports, and supporting claim documentation
• Ensure claims are processed in accordance with company policies and regulatory standards
• Conduct claim investigations when required, including communicating with claimants, witnesses, and internal/external partners
• Interpret policy coverage to determine liability and benefits payable
• Evaluate damages or losses and calculate appropriate settlement amounts
• Communicate clearly with claimants and stakeholders regarding claim status, documentation needs, and outcomes
• Recommend claim approvals, denials, or negotiated settlements
• Maintain accurate, well-organized claim files and documentation
• Generate reports on claim activity, trends, and processing status
• Stay current on industry regulations, insurance products, and best practices
• Deliver excellent customer service while maintaining efficiency and accuracy
• Perform other duties as assigned

Qualifications

Education

• High School Diploma or equivalent (required)

Experience

• Prior medical claims processing experience required
• Experience using claims processing software and related tools

Competencies & Skills

• Highly motivated and results-driven
• Strong verbal, written, and interpersonal communication skills
• Excellent analytical and problem-solving abilities
• Strong attention to detail with a high level of accuracy
• Ability to adapt in a fast-paced, changing environment
• Basic mathematical proficiency
• Intermediate typing skills
• Basic computer proficiency
• Knowledge of medical terminology, ICD-9/ICD-10, CPT, HCPCS, and HIPAA regulations (preferred)
• Knowledge of insurance policies, regulations, and industry best practices (preferred)

Additional Requirements

• Ability to download and use required 2-factor authentication applications on a personal device
• Ability to successfully pass pre-employment screening, including background check, work authorization verification, and drug test

Work Environment

• This position may be performed remotely from home or onsite as business needs require

Physical Demands

• Ability to sit for extended periods
• Frequent use of hands and fingers for typing and computer work
• Regular talking and hearing
• Close vision required for computer and device use
• Occasional standing, walking, stair climbing, and lifting up to 25 pounds

Benefits

• 401(k)
• 401(k) matching
• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• Flexible Spending Account (FSA)
• Paid time off (PTO)
• Employee Assistance Program
• Referral program

Equal Employment Opportunity

Firstsource is an Equal Employment Opportunity employer. All employment decisions are based on valid job requirements without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, veteran status, or any other protected characteristic.

Firstsource is also an Affirmative Action employer and actively encourages applications from minority groups, females, protected veterans, and individuals with disabilities.