Medical Insurance Denials & Claims Follow-Up Specialist

Job Opening: Administrator
Location: South Africa (Remote)
Type: Full-Time, Work from Home
Hours: Monday to Friday: 9am- 5pm EST (US Hours)

Salary: South African Rand (ZAR)

We are seeking an organised, persistent, and detail-oriented Medical Insurance Denials & Claims Follow-Up Specialist to support a US-based healthcare operation.

The successful candidate will be responsible for reviewing outstanding insurance claims and denial reports, investigating payment issues, and following up with insurance companies until claims are resolved.

This role requires someone who takes ownership, follows through consistently, and is comfortable dealing with insurance providers to resolve outstanding claims.

Key Responsibilities

• Review medical billing, outstanding claims, and insurance denial reports.
• Investigate denied, rejected, underpaid, or unpaid insurance claims.
• Contact insurance companies to obtain claim updates and determine reasons for non-payment.
• Follow up consistently on outstanding claims until resolution.
• Identify the information or corrections required to resolve claim issues.
• Correct and resubmit claims where necessary.
• Maintain accurate and detailed notes of all follow-up activities.
• Track claims throughout the resolution process.
• Identify recurring denial trends or billing issues.
• Escalate complex or recurring issues when appropriate.
• Communicate claim updates clearly to relevant internal stakeholders.

Ensure outstanding items are followed through and not left unresolved

Requirements

• Previous medical billing, medical claims, health insurance, or revenue cycle experience is preferred.
• Experience working with US healthcare insurance would be advantageous.
• Strong organisational and administrative skills.
• Excellent attention to detail and accuracy.
• Confident and persistent when following up with insurance companies.
• Strong problem-solving and investigative skills.
• Professional and pleasant communication style.
• Ability to maintain detailed and accurate records.
• Strong written and verbal English communication skills.
• Ability to manage multiple outstanding claims and priorities simultaneously.
• Comfortable working independently with minimal supervision.
• Reliable follow-through and a strong sense of accountability.

Benefits

1. Comfortable working U.S. hours
2. Remote work from home

Fraud Disclaimer:  ReWorks Solutions will never request payment during recruitment or require in-person office visits. All official communication will come from a ReWorks Solutions email address. Please verify any suspicious messages with our team directly.