Job Overview Lensa, a leading staffing and recruitment firm based in Plano, Texas, is seeking a skilled Health Insurance Claims Processor to join our remote team. In this pivotal role, you will handle the end-to-end processing of health insurance claims, ensuring accuracy, compliance with regulations, and timely reimbursements to policyholders and providers. This position offers the flexibility of remote work, allowing you to contribute to the healthcare industry from anywhere while supporting Lensa's mission to connect top talent with innovative opportunities. Key Responsibilities As a Health Insurance Claims Processor, you will review incoming claims for completeness and validity, verifying policy coverage, eligibility, and supporting documentation. You will code and classify claims using standard medical billing codes such as ICD-10 and CPT, investigate discrepancies, and coordinate with healthcare providers for additional information when needed. Adjudicating claims involves calculating payments, applying deductibles, copays, and coinsurance accurately, while denying invalid claims with clear explanations. You will maintain detailed records in claims management systems, generate reports on processing metrics, and respond to inquiries from policyholders, providers, and internal teams. Staying updated on industry regulations, payer guidelines, and changes in healthcare policies is essential to minimize errors and appeals. Collaboration with cross-functional teams, including underwriters and customer service, will ensure seamless operations and high customer satisfaction. Required Qualifications Candidates must have a high school diploma or equivalent, with an associate's or bachelor's degree in health information management, business administration, or a related field preferred. At least 2-3 years of experience in health insurance claims processing, medical billing, or a similar role is required. Familiarity with electronic health records (EHR) systems and claims software like Availity, Change Healthcare, or Epic is essential. Certification as a Certified Professional Coder (CPC) or Certified Billing and Coding Specialist (CBCS) is highly desirable. Skills Strong analytical skills are crucial for interpreting complex medical documentation and financial data. Proficiency in Microsoft Office Suite, especially Excel for data analysis and reporting, is necessary. Excellent attention to detail, organizational abilities, and time management skills will help meet daily processing volumes and deadlines. Effective communication, both written and verbal, is key for interacting with diverse stakeholders. Problem-solving aptitude and the ability to handle high-pressure situations with accuracy are vital. Knowledge of HIPAA privacy rules and healthcare reimbursement methodologies, including Medicare and Medicaid, will set you apart. Company Info Lensa is a dynamic company specializing in talent solutions, helping professionals find rewarding careers in various industries, with a strong focus on healthcare and insurance. Headquartered in Plano, TX, we pride ourselves on fostering an inclusive, innovative culture that values work-life balance and professional growth. Benefits We offer competitive compensation, comprehensive health, dental, and vision insurance, 401(k) with company match, paid time off, and remote work stipends. Additional perks include professional development reimbursements, wellness programs, and employee assistance services. Growth Opportunities At Lensa, career advancement is a priority. High performers can progress to senior processor, claims supervisor, or analyst roles, with access to training programs, certifications support, and leadership development initiatives. Join us to build a lasting career in the evolving healthcare sector.