Help keep claims accurate and compliant while working fully from home. If you’re detail-obsessed, fluent in claims coding, and ready to be a go to resource on complex cases, this Senior Claims Examiner role is built for you.
About BroadPath
BroadPath partners with leading healthcare organizations to deliver specialized, work from home support in claims, utilization management, and member services. As a Senior Claims Examiner, you’ll handle complex claims for SCCIPA contracted plans, helping protect financial integrity while supporting quality patient care. BroadPath offers structured training, clear workflows, and a supportive remote culture so you can do focused, high quality work.
Schedule
- Fully remote role within the United States
- Training: 5 days, Monday–Friday, 8:00 a.m. – 5:00 p.m. PST
- Production: Monday–Friday, 8:00 a.m. – 5:00 p.m. PST
- No weekends
What You’ll Do
⦁ Adjudicate all types of claims, resolving system edits and audits for both hardcopy and electronic submissions
⦁ Resolve provider and eligibility issues related to received claims
⦁ Generate emergency reports and authorizations when claims are missing prior authorization
⦁ Adjudicate third party liability and coordination of benefits claims in line with policy
⦁ Review stop loss reports and identify members approaching reinsurance levels
⦁ Flag and report potential system programming issues to supervisors
⦁ Provide technical support, guidance, and training to claims processors
⦁ Identify and route carved out services based on plan contracts
⦁ Process claims using knowledge of plan contracts, provider pricing, eligibility, referral and authorization procedures, benefits, and capitation arrangements
⦁ Ensure correct posting of claims information to the appropriate general ledger accounts
⦁ Partner with Customer Service and Provider Services on large claim projects and adjustments
⦁ Assist with benefit and plan interpretation through the cut log system when needed
⦁ Adjust complex claims and support other examiners in resolving difficult cases
What You Need
⦁ High school diploma or equivalent
⦁ At least 2 years of experience processing both regular and complex claims
⦁ Proficiency in ICD 9, CPT, HCPC, and revenue coding
⦁ Strong written and verbal communication skills with the ability to collaborate across departments
⦁ Ability to analyze, troubleshoot, and resolve complex claims issues independently
⦁ Comfortable working in a high volume, production driven environment
⦁ Strong attention to detail and focus over extended periods of time
⦁ Consistent performance under demanding production and quality standards
⦁ Technical proficiency with claims processing software and related tools
⦁ Solid understanding of medical terminology and complex claims procedures
⦁ Knowledge of HEDIS, DOC, HCFA, and NCQA requirements
⦁ Ability to act as a subject matter resource and trainer for other processors
Benefits
⦁ Competitive base pay at 18 dollars per hour
⦁ Weekly pay schedule
⦁ Fully remote, Monday through Friday schedule with no weekends
⦁ Opportunity to specialize further in complex claims and high level adjudication
⦁ Inclusive, diverse culture that values your experience and perspective
Senior level claims roles with a true work from home setup and weekday only hours don’t stay open long, so this is the time to move.
If you’re ready to take the next step in your claims career and be the expert others rely on, this role is a strong fit.
Happy Hunting,
~Two Chicks…