Medical Claims & Authorization Specialist at Affinity International

About this role

Location: Remote – South Africa Employment Type: Full-Time Working Hours: US Eastern Time (EST/EDT) Business Hours Company: US-Based Healthcare Organisation Overview
We are recruiting on behalf of our client for a Medical Claims & Authorization Specialist to join a US-based healthcare organisation on a fully remote basis.
The role focuses on managing medical insurance claims, following up on outstanding payments, resolving claim denials, handling appeals, and ensuring timely reimbursement from insurance providers.
The successful candidate will have experience in medical billing, medical claims administration, or healthcare accounts receivable, with strong attention to detail and the ability to manage a high volume of accounts independently.
Full training on the company's systems, processes, and specific insurance providers will be provided.
Key
Follow up with insurance companies regarding unpaid, delayed, denied, and underpaid medical claims through telephone calls and online portals.
Review rejected and denied claims, identify reasons for non-payment, correct discrepancies, and arrange resubmissions.
Prepare and submit insurance appeals with the necessary supporting documentation.
Monitor outstanding medical accounts and accounts receivable aging reports to ensure timely payment collection.
Verify insurance information, claim statuses, and authorization details where required.
Maintain accurate records of all claim activity, insurance communications, and account updates.
Identify recurring billing issues, claim denials, and payment discrepancies, escalating them where necessary.
Liaise with healthcare providers, clinics, and internal teams to obtain missing information and resolve outstanding claims.
Ensure all claims, follow-ups, and appeals are handled within the required deadlines and insurance guidelines.
Requirements
Matric (Grade 12) qualification as a minimum.
Minimum 2 years of experience in medical billing, medical claims administration, healthcare accounts receivable, or a related field.
Previous experience working with US medical insurance claims and billing processes is highly advantageous.
Understanding of medical claims processing, insurance payments, rejected claims, and accounts follow-ups.
Familiarity with medical coding terminology, including ICD-10, CPT, or HCPCS, is advantageous.
Strong computer literacy, including Microsoft Excel or Google Sheets.
Excellent written and verbal English communication skills.
Ability to work independently, manage multiple accounts, and meet deadlines.
Reliable home office setup with a stable internet connection.
Availability to work US Eastern business hours.
Preferred Experience
Experience working with US healthcare providers, medical billing companies, or healthcare outsourcing organizations.
Knowledge of US insurance providers, including Medicare, Medicaid, Aetna, Cigna, and .
Experience using insurance portals such as Availity or similar platforms.
Familiarity with Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), and insurance denial codes.
Experience handling insurance appeals, claim resubmissions, and outstanding medical debtors.
Exposure to medical billing software, practice management systems, or electronic health records (EHR).
Key Competencies
Strong attention to detail and accuracy.
Excellent organisational and time-management skills.
Confident and professional telephone communication.
Strong problem-solving and analytical abilities.
Ability to manage high volumes of claims and accounts.
Self-motivated, reliable, and capable of working independently.
Willingness to learn new systems, processes, and US insurance requirements.
Working Arrangements
Fully remote position based in South Africa.
Full-time employment aligned with US Eastern business hours.
Opportunity to work with an established US healthcare organisation.
Training provided on company-specific systems and processes.
Originally posted on Himalayas