Claims Specialist

Description

Summary: This role involves independently managing, tracking, and resolving Out-of-Network (OON) commercial insurance claims for U.S.-based healthcare providers, requiring high-volume payer outreach and denial management. Highlights: 1. Independently manage and resolve Out-of-Network commercial insurance claims 2. Engage in high-volume payer outreach and denial management workflows 3. Drive claims to resolution with minimal supervision Job description: **Before You Apply** This role requires **hands\-on, prior experience** working Out\-of\-Network (OON) commercial insurance claims in a U.S. healthcare billing environment. Candidates without direct OON claims experience will not be considered, regardless of general healthcare or customer service background. **This position is 100% on\-site in Barranquilla, Colombia.** **About the Role** Venture Global Solutions is hiring an experienced Claims Follow\-Up Representative to independently manage, track, and resolve Out\-of\-Network (OON) commercial insurance claims for U.S.\-based healthcare providers. The right candidate arrives ready to work claims from day one. You will be expected to handle high\-volume payer outreach, navigate denial management workflows, and drive claims to resolution with minimal supervision. Training is limited to our internal platform (NextGen) not to OON processes, which you must already know. **Key Responsibilities** * Manage a daily minimum of 75 OON commercial insurance claims independently * Conduct high\-volume outbound calls directly to U.S. insurance payers to investigate statuses, dispute denials, and escalate unresolved claims * Identify denial patterns, submit formal appeals, and follow escalation protocols to maximize reimbursement * Maintain real\-time, flawless documentation of all claim actions, reference numbers, and payer responses in EMR and shared spreadsheets * Compile and submit complete medical record packages for appeals and audits, ensuring internal review prior to submission **Requirements (All items are mandatory)** * **Minimum 1 year of direct, hands\-on experience** in Out\-of\-Network (OON) commercial insurance claims follow\-up (not general billing or customer service) * Proven experience in **denial management, payer communications, and claims appeals** in a U.S. healthcare context * Ability to work **independently and meet strict daily KPIs** * Proficiency with **EMR systems** (NextGen experience is a plus but not required) * Advanced use of **Excel or Google Sheets** for claims tracking * **Excellent spoken and written English** **To Apply:** Email your resume to Michelle@ventureglobalsolution.com Job Type: Full\-time Work Location: In person