Job Summary

InfoTech Solutions is seeking a detail-oriented, analytical, and dependable Work From Home Claims Processor specializing in US healthcare payer claims. In this role, you will review, validate, and process medical claims with accuracy and compliance, ensuring adherence to payer rules, HIPAA regulations, and RCM best practices. This position requires experience with claims adjudication, healthcare billing standards, insurance verification, and denial resolution. You will play a vital part in ensuring timely reimbursement and maintaining high-quality data integrity for our healthcare clients.

Key Responsibilities

• Review, evaluate, and process medical claims according to payer policies, coding guidelines, and compliance standards.

• Verify claim data for completeness, accuracy, and eligibility before submission.

• Analyze claim information, identifying discrepancies, missing details, and documentation requirements.

• Apply knowledge of CPT, HCPCS, ICD-10, and NCCI guidelines to determine claim accuracy.

• Resolve claim errors, rejections, and denials by verifying codes, documentation, and payer rules.

• Maintain up-to-date knowledge of major US healthcare payers including Medicare, Medicaid, and commercial insurance plans.

• Ensure strict adherence to HIPAA guidelines, data security protocols, and confidentiality standards.

• Communicate with internal teams to clarify claim issues or obtain missing information.

• Track claim statuses, follow up on pending items, and ensure timely claim completion and submission.

• Generate daily/weekly reports on claim volumes, status, and error trends.

• Participate in continuous improvement initiatives and process optimization activities.

Required Skills and Qualifications

• Strong understanding of US healthcare claims processing, payer policies, and medical billing workflows.

• Proficiency in CPT, ICD-10, HCPCS coding structures and medical terminology.

• Familiarity with EOBs, ERAs, and payer claim adjudication systems.

• Excellent analytical and problem-solving skills with a focus on accuracy.

• Strong computer literacy and experience using EMR/EHR or billing platforms.

• Ability to manage high-volume claims with speed and precision.

• Excellent written and verbal communication skills.

• High level of integrity, confidentiality, and compliance awareness.

• Ability to work independently in a remote environment.

Experience

• Minimum 1–3 years of experience in claims processing or US medical billing.

• Experience working with US healthcare payers (Medicare, Medicaid, or commercial).

• Prior experience in RCM, insurance verification, or denial management is highly desirable.

Working Hours

• Fully remote work-from-home role.

• Standard schedule aligned with US business hours (EST/CST/PST depending on client need).

• Occasional flexibility may be required based on workload and deadlines.

Knowledge, Skills, and Abilities

• Strong understanding of medical claim workflows, billing regulations, and payer guidelines.

• Ability to interpret clinical and billing documentation.

• High attention to detail, accuracy, and quality control.

• Proficient in data entry and claim management software.

• Ability to work in a fast-paced, deadline-driven environment.

• Strong organizational skills and ability to prioritize effectively.

• Commitment to continuous learning and process improvement.

Benefits

• Competitive salary and performance-based incentives.

• Remote work flexibility with structured training support.

• Health insurance benefits (as applicable).

• Opportunities for career advancement within the RCM domain.

• Professional development, certification support, and skill-building programs.

• Supportive team environment with ongoing coaching and mentorship.

Why Join InfoTech Solutions

At InfoTech Solutions, we pride ourselves on delivering excellence in healthcare operations. By joining our team, you become part of an innovative environment where accuracy, growth, and teamwork are celebrated. We support our employees with continuous learning opportunities, a stable remote work culture, and impactful work that contributes directly to the revenue integrity of our clients. Your expertise helps shape high-quality healthcare outcomes.

How to Apply

Interested candidates may submit their updated resume, along with a brief cover letter outlining relevant experience, to our recruitment team us
Shortlisted applicants will be contacted for a virtual interview and skills assessment.