Work from home reviewing complex medical claims for accuracy, compliance, and proper payment. This full time remote Senior Claims Examiner role is ideal if you have hands on health insurance claims experience and want stable weekday hours with no weekends.
About BroadPath
BroadPath partners with leading health plans and provider organizations nationwide to deliver high quality operations support. Their teams are 100 percent remote, performance driven, and built around clear processes and collaboration. As a Senior Claims Examiner, you help protect both financial integrity and quality patient care.
Schedule
- Full time, remote, W2
- Training: Monday–Friday, 8:00 a.m. to 5:00 p.m. PST (5 days)
- Regular schedule: Monday–Friday, 8:00 a.m. to 5:00 p.m. PST
- No weekends
What You’ll Do
- Review and adjudicate complex and standard medical claims from hardcopy and electronic submissions.
- Resolve system edits, audits, and provider or eligibility issues tied to received claims.
- Process third party liability and coordination of benefits claims according to policy and contract terms.
- Generate emergency reports and authorizations for claims missing prior authorization.
- Identify and route carved out services and stop loss cases based on plan contracts and reinsurance levels.
- Ensure accurate posting of claim information to the correct general ledger accounts.
- Support large claim projects and adjustments with Customer Service and Provider Services.
- Provide technical support, guidance, and informal training to claims processors.
- Help interpret benefits and plan details to support accurate adjudication.
- Meet or exceed production and quality standards in a high volume environment.
What You Need
- High school diploma or equivalent (required).
- At least 2 years of experience processing both regular and complex health insurance claims.
- Strong working knowledge of ICD 9, CPT, HCPCS, revenue coding, and medical terminology.
- Familiarity with HEDIS, DOC, HCFA, and NCQA requirements.
- Experience using claims processing systems and related software.
- Ability to analyze and troubleshoot complicated claim issues independently.
- Detail oriented focus with the ability to stay accurate over long review periods.
- Solid written and verbal communication skills and comfort working cross functionally.
- Willingness to act as a resource and mentor to other claims processors.
Benefits
- Base pay of 18 dollars per hour.
- Weekly pay.
- Fully remote work from home within the United States.
- Stable weekday schedule with no weekends.
- Inclusive, supportive culture focused on performance and development.
If you have deep claims experience and want a fully remote Senior Claims Examiner role with predictable weekday hours, this is a strong opportunity to pursue.
Happy Hunting,
~Two Chicks…