If you’re the person people hand the messy, high-dollar claims to because you actually know how to untangle them, this is your lane. You’ll adjudicate complex claims end-to-end and help keep accuracy, compliance, and turnaround time on point, all from home.
About BroadPath
BroadPath is a work-from-home company supporting healthcare organizations with services that keep operations running smoothly and members supported. They build remote teams focused on quality, speed, and consistency. They also emphasize an inclusive culture that values different backgrounds and perspectives.
Schedule
- Fully remote (United States)
- Training: 5 days, Monday–Friday, 8:00 AM–5:00 PM PST
- Production: Monday–Friday, 8:00 AM–5:00 PM PST
- No weekends
- Pay: $18/hour, paid weekly
What You’ll Do
- Adjudicate complex claims (hardcopy and electronic), resolving edits and audits
- Resolve provider and eligibility issues tied to incoming claims
- Generate emergency reports and authorizations when prior auth is missing
- Process third-party liability and coordination of benefits claims per policy
- Review stop loss reports and flag members nearing reinsurance thresholds
- Identify possible system programming issues and escalate to leadership
- Provide technical support and training to claims processors and peers
- Route carved-out service claims appropriately based on plan contracts
- Apply plan contract knowledge, provider pricing, eligibility, referrals, benefits, and capitation rules to ensure accurate processing
- Ensure claims post correctly to the appropriate general ledger accounts
- Partner with Customer Service and Provider Services on large-claim projects, adjustments, and escalations
- Assist with benefits and plan interpretation using the cut-log system
- Adjust complex claims and support other examiners with resolution work
- Handle additional tasks as assigned
What You Need
- High school diploma or equivalent
- 2+ years experience processing regular and complex medical claims
- Proficiency in ICD-9, CPT, HCPC, and revenue coding
- Strong knowledge of complex claims procedures and medical terminology
- Ability to troubleshoot independently and resolve complex claim issues
- Comfort working in a high-volume, production-driven environment
- Strong focus, detail-orientation, and accuracy under strict quality standards
- Technical proficiency with claims processing software
- Knowledge of HEDIS, DOC, HCFA, and NCQA requirements
- Ability to serve as a go-to resource and trainer for claims processors
Benefits
- Work from home
- No weekends
- Weekly pay
- Consistent weekday schedule (PST hours)
These remote healthcare roles can fill quickly. If you’ve got the coding knowledge and complex claims experience, get your resume in while it’s open.
This is the kind of role where your accuracy protects both the plan and the patient. If you like being the fixer, you’ll fit right in.
Happy Hunting,
~Two Chicks…