If you’re past basic claims entry and you like being the person who catches the weird stuff, fixes the complex stuff, and keeps the money accurate, this is that role. You’ll adjudicate everything from routine claims to messy, high-stakes adjustments while supporting providers, members, and internal teams.
About BroadPath
BroadPath builds high-performing remote teams that support healthcare organizations across claims, utilization management, and member services. They’re known for structured work-from-home schedules and a quality-first approach to operational work.
Schedule
Training: 5 days, Monday–Friday, 8:00 AM–5:00 PM PST
Production: Monday–Friday, 8:00 AM–5:00 PM PST (no weekends)
What You’ll Do
• Adjudicate routine and complex claims, resolving edits and audits for both paper and electronic submissions
• Communicate with providers and members on claims, eligibility, and authorization issues
• Generate emergency reports and authorizations for claims without prior approval when needed
• Process third-party liability and coordination of benefits claims according to policy
• Support stop-loss review work by flagging members nearing reinsurance thresholds
• Escalate possible system/programming issues to leadership for correction
• Provide guidance and training support to less experienced claims processors
• Identify and route carved-out services per plan contracts
• Apply contract and benefit knowledge, including provider pricing, capitation, eligibility, and referral/authorization rules
• Collaborate with Accounting to ensure claims post accurately to general ledger accounts
• Partner with Customer Service and Provider Services on large claim projects and adjustments
• Interpret plan details using the cut-log system when needed
• Assist senior examiners with complex adjustments and support other tasks as assigned
What You Need
• High school diploma or equivalent
• 1–3 years of medical claims processing experience
• Medicare claims experience
• Knowledge of ICD-9, CPT, HCPCS, and revenue codes
• Strong analytical/problem-solving skills and comfort troubleshooting claim issues
• Strong communication skills and professional customer service presence
• High attention to detail in a high-volume production environment
• Comfort with claims systems and adapting quickly to new tools
• Understanding of medical terminology, coding, and healthcare regulations
• Ability to learn and apply complex policies while hitting performance standards
• Team mindset, including supporting and coaching others
Systems
• QXNT experience
Benefits
• $17.00/hour base pay
• Weekly pay
• Weekday schedule with no weekends
• Inclusive workplace and equal opportunity employer
• Accommodation support available through HR (upon request)
This is a good “level up” role if you want more ownership than straight processing, without stepping fully into management.
Happy Hunting,
~Two Chicks…