A U.S.-based client is seeking an experienced Medical Insurance Claims Specialist to join its team remotely.

The adecuado candidate has a solid understanding of U.S. health insurance and hands-on experience reviewing, processing, and resolving medical and related insurance claims. This role requires strong attention to detail, critical thinking, problem-solving skills, excellent communication, and the ability to work independently and take initiative.

Key Responsibilities

- Examine, process, and calculate medical and related insurance claims.
- Review claim filings, supporting documentation, and reports for completeness and accuracy.
- Process claim reimbursements in a timely manner.
- Assist with short-term and long-term disability claims.
- Assist with medication-related issues, prior authorizations, and appeals.
- Verify benefits and provide accurate insurance information to providers.
- Respond to inquiries regarding claim status, coverage, and policy interpretation.
- Communicate with clients, claimants, and providers by phone, email, and fax.
- Analyze claim issues, gather required documentation, and resolve discrepancies.
- Identify urgent claims and coordinate with internal teams to prevent backlog.




- Escalate complex or unresolved matters when appropriate.
- Document all communications accurately in internal systems.
- Maintain confidentiality and comply with HIPAA and company policies.

Requirements

- Previous experience handling U.S. medical or health insurance claims.
- Solid understanding of health insurance, benefits, coverage, and claims processes.
- Strong attention to detail and accuracy.
- Strong critical thinking and problem-solving skills.
- Excellent written and verbal English communication skills.
- Strong client communication and customer service experience.
- Experience with prior authorizations, appeals, and benefit verification preferred.
- Ability to work independently, take initiative, and manage multiple priorities.
- Experience with insurance or claims management systems preferred.
- Understanding of HIPAA compliance and confidentiality requirements.

What We Offer

- 100% remote opportunity.
- Full-time position supporting a U.S.-based client.
- Professional growth and exposure to health insurance claims operations.
- Collaborative and supportive work environment.

📌 Commercial Insurance Verification Specialist (Colombia)
🏢 Horizon Premier Staffing
📍 Colombia