We are seeking a highly motivated and productivity-driven Claims Follow-Up Representative to join our team. This role focuses exclusively on managing and resolving out-of-network (OON) commercial insurance claims. You will be responsible for directly contacting insurance payers to investigate claim statuses, appeal denials, and optimize overall workflow efficiency. This position requires high-volume phone outreach and meticulous electronic documentation.

Key Responsibilities

- High-Volume Claim Management: Manage, review, and work a strict minimum of 75 commercial insurance claims per day.

- Direct Payer Contact: Conduct phone calls for every single claim to resolve issues directly with insurance payers; portal-only research is insufficient.

- Denial Tracking & Escalations: Identify high-dollar claims for prioritization and follow standard protocols for denial follow-ups and payer escalations.

- Data Documentation: Maintain flawless, real-time documentation of claim actions within our EMR system and shared spreadsheets.

- Medical Records Assembly:



Compile necessary medical records for insurance requests, ensuring no records are sent to payers without internal review and consent.

Requirements

- Industry Experience: Minimum 6m - 2 years of experience focusing specifically on out-of-network (OON) commercial insurance claims follow-up.

- Communication Skills: Excellent verbal communication skills with a proven track record of handling high-volume professional phone outreach to insurance payers.

- Technical Proficiency: Hands-on experience navigating Electronic Medical Record (EMR) systems and working with shared spreadsheets (Excel/Google/Zoho Sheets).

- Efficiency: Proven ability to meet strict daily performance, quality, and productivity metrics.

- Attention to Detail: Sharp organizational skills required for capturing claim reference numbers and assembling medical record packages accurately.

📌 Out-of-Network Medical Claims Specialist (Barranquilla)
🏢 Venture Global Solutions
📍 Barranquilla