Medical Insurance Denials & Claims Follow-Up Specialist

Job Opening: Medical Insurance Denials & Claims follow-up Specialist 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