Remote Health Claims Specialist – Work from Home (Texas, USA)

Job Description

Job Title: Health Claims Specialist / Claims Adjudicator
Location: Remote – Texas (USA)
Job Type: Full-Time, Permanent
Company: Sutherland

Company Overview

Sutherland is seeking detail-oriented and self-motivated individuals for a fully remote Health Claims Specialist role. This position involves processing healthcare claims accurately according to client-specific guidelines. It is not a customer-facing role, but a data entry and analytical position where you will ensure claims are adjudicated correctly and confidentially in compliance with HIPAA regulations.

Job Responsibilities

• Independently process healthcare claims through data entry for most of the day.
• Adjudicate claims accurately, meeting production, quality, and regulatory guidelines.
• Follow up on claims requiring additional information and escalate complex claims to a Lead or Auditor.
• Maintain the integrity and confidentiality of all sensitive information.
• Use specific claims processing software as required.
• Participate in special projects as assigned.
• Achieve Key Performance Indicators (KPIs) and quality goals throughout training and ongoing work.

Qualifications & Skills

Required Skills:

• Strong data entry proficiency
• Time management and multitasking abilities
• High attention to detail and analytical thinking
• Strong typing skills (minimum 40 WPM)
• Effective verbal and written communication skills
• Knowledge of medical terminology
• Familiarity with medical billing, coding, and insurance processes (Medicare, Medicaid, Child Plus)
• Previous experience in a medical office or healthcare claims setting is preferred

Technical Requirements:

• High-speed, hardwired internet connection (2 Mbps upload / 10 Mbps download minimum)
• Quiet, secure, distraction-free home workspace
• Proficiency with computer applications and claims processing software

Education Requirements:

• High School Diploma or equivalent
• Medical Billing and Coding degree/certification preferred

Benefits

• Hourly pay of $13.50 with potential monthly bonuses up to $1,500
• Medical, dental, and vision plans
• Paid training and PTO (Global Flexible Vacation Policy)
• Company-provided equipment
• Advancement opportunities – 80% of frontline leaders promoted from within
• Monthly rewards and recognition programs
• Employee discounts and wellness programs (including access to a personal trainer)
• Weekday schedule: Monday – Friday, 8:30 AM – 5:00 PM EST

Why Join Sutherland?

• Fully remote position offering work-life balance
• Opportunity to grow within a global company
• Supportive team environment with training and mentorship
• Work in a highly structured, professional, and HIPAA-compliant setting