Claims Representative -Work From Home (Healthcare)

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

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Job Description:

Sagility, a global leader in business process management, is dedicated to enhancing the member and patient experience. By combining cutting-edge technology with decades of healthcare expertise, we deliver exceptional results for our clients.

If you are detail-oriented, analytical, and thrive in a structured environment, this is your opportunity to build a career in healthcare operations. Sagility is actively building a pipeline of qualified Claims Representatives to support upcoming classes. Early applicants will be prioritized for interview scheduling and for consideration of offers.

As a Claims Representative, you will review and process medical, dental, or supplemental insurance claims according to eligibility guidelines, benefits, and internal policies. Our structured training program prepares you for success through instructor-led virtual sessions, hands-on learning, and progressive performance goals. Once training is complete, you will be responsible for meeting established quality, productivity, and accuracy standards.

If you are motivated, reliable, and ready to grow your career in healthcare, we encourage you to apply as soon as possible.

Become Part of a Team That S.O.A.R,s!

• S Spark Curiosity
• O One Team, One Direction
• A Action for Results
• R Right by Right Purpose

Benefits You Will Enjoy

• Competitive pay: $18.00/hour
• Performance-based incentives
• Paid training in a cutting-edge virtual training environment
• Comprehensive health coverage (available after 90 days)
• Employee wellness and engagement programs.
• Career advancement opportunities: 90% of our leaders started as Customer Service Representatives

What You Will Do

• Review and process insurance claims accurately using internal guidelines and benefit plans • Research and navigate multiple systems and documents to validate claim details • Confirm required documentation is included and identify missing information • Verify accuracy of medical coding (CPT/ICD-10 preferred) • Evaluate eligibility, coverage, authorizations, and coordination of benefits • Identify discrepancies and resolve errors using established procedures • Maintain productivity and quality standards in a fast-paced environment • Work independently while collaborating with supervisors, coaches, and trainers • Use multiple computer applications and virtual tools such as Outlook, Webex, and internal systems • Continuously improve efficiency through feedback and training support

What You Bring

• High school diploma or equivalent • Ability to quickly learn new systems and processes • Experience using Microsoft Outlook (email, calendar invites, attachments) • Basic Microsoft Excel skills (sorting/filtering) • Ability to navigate multiple systems using shortcuts and efficient workflows • Strong attention to detail and ability to follow complex procedures • Excellent time management and organizational skills • Ability to meet productivity and quality performance expectations • Experience working independently in a remote environment preferred • Familiarity with healthcare terminology, insurance claims, CPT or ICD-10 coding preferred • Previous claims processing or related administrative experience preferred

Job Requirements

• Must be at least 18 years of age • Minimum 1 year of consistent employment history (customer service or administrative experience preferred) • Reliable attendance required, especially during the first 90 days • Typing speed of at least 25 WPM • Hardwired internet connection with minimum speeds of 25 Mbps download and 10 Mbps upload • Secure, private workspace free from distractions • Flexible availability, including weekends as business needs require

Benefits & Perks

• Daily Pay options available • Medical, Dental, and Vision coverage • Life Insurance • Short-Term and Long-Term Disability options • Flexible Spending Account (FSA) • Employee Assistance Program • 401(k) with employer contribution • Paid Time Off (PTO) • Tuition Reimbursement

Sagility is an Equal Opportunity Employer/Veteran/Disability.

Alert: Please beware of fraudulent communications from profiles impersonating Sagility or its employees. All official communication from Sagility will come from our verified email domains: “@sagility.com” or “@sagilityhealth.com”. Sagility will never ask for payments for job offers, interviews, or otherwise. Do not respond to suspicious communications, whether via email, WhatsApp, or any social platform. For any concerns, contact us directly through our official website.

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