About the job

Company Description Venture Integral Solutions (VGS S.A.S) is a leading business process outsourcing (BPO) company based in Barranquilla, Colombia, serving clients worldwide. The organization delivers high-quality services across customer service, technical support, data entry, and back-office operations. By leveraging modern technologies and proven best practices, VGS provides cost-effective, tailored solutions that support diverse business needs. The company’s focus on quality, efficiency, and reliability has earned it a reputation as a trusted partner for organizations of all sizes. Venture Global Solutions helps clients streamline operations, enhance customer satisfaction, and support global growth.

Role Description The Claims Insurance Specialist is a full-time, on-site role based in Barranquilla, Colombia for an orthopedic surgery center located in the United States. This role is responsible for reviewing, processing, and validating insurance claims to ensure accuracy, completeness, and compliance with policy terms and regulatory guidelines. The specialist will investigate claim details, gather and analyze supporting documentation, and coordinate with insurance carriers, brokers, and internal teams to resolve discrepancies and expedite claim decisions. Daily tasks include communicating with customers and stakeholders, updating claim records in internal systems, preparing reports on claim status and trends, and escalating complex cases when necessary. The role also involves collaborating with finance and operations to support accurate billing, payment reconciliation, and continuous process improvements in claims handling.

Key Responsibilities:

- Claim Management: Proactively track and resolve out of network insurance claims. Work on 75-80 claims daily




- Direct Payer Contact: Conduct outbound calls to insurance companies to dispute and investigate claim statuses.
- Denial & Escalation: Identify denial patterns, submit formal appeals, and escalate unresolved claims to maximize reimbursement.
- Data Documentation: Maintain precise records by capturing claim reference numbers, call notes, and payer responses.
- Medical Records Assembly: Gather, organize, and submit comprehensive medical record packages for appeals and audits.

Qualifications

- Strong knowledge and practical experience in Insurance, including claims processes, policy interpretation, and relevant regulations.
- 6 months to 2 years experience in Out-of-Network (OON) insurance claims follow-up, healthcare billing or similar.
- Foundational understanding in the difference between In-network and out-of-network insurance claims and finance concepts related to claims payments, billing, reconciliations, and reporting.
- Excellent Communication skills, with the ability to explain complex information clearly in writing and verbally.
- Proven Customer Service skills, including empathy, patience, and professionalism when handling sensitive or high-pressure situations.
- Attention to detail and strong organizational skills for managing multiple claims and deadlines simultaneously.
- Proficiency with office software and claims or CRM systems; ability to quickly learn new tools and platforms.
- Prior experience in insurance claims, health insurance, property and casualty, or a similar environment is highly beneficial.
- Ability to work on-site full-time in Barranquilla, Colombia and collaborate effectively in a fast-paced team setting.

To apply: Email your resume to [email protected]

Lugar de trabajo: Empleo presencial

📌 Medical Billing (Colombia)
🏢 Venture Global Solutions
📍 Colombia