Claims Specialist - Healthcare (SDQ)

Position Summary:

Horatio is hiring RCM Specialists to manage post-submission healthcare claims for a U.S. organization. Operating within the CandidHealth platform, you will execute SOP-driven workflows, including denial management, appeals, and prior authorizations to ensure timely revenue recovery. This role requires close attention to detail and expertise in healthcare insurance workflows.

Responsibilities:

• Conduct outbound calls to payers to investigate and resolve claim denials.
• Maintain precise call notes and claim updates within CandidHealth.
• Retrieve medical records and upload them to payer portals like UHC, Optum, and Availity.
• Process claim appeals following strict client SOPs and track progress to completion.
• Identify authorization issues on denied claims and coordinate required documentation for approval.
• Process claim appeals following strict client SOPs and track progress to completion.
• Identify authorization issues on denied claims and coordinate required documentation for approval.

Required Skills/Abilities:

• 1–3 years in Healthcare RCM or medical billing.
•  Experience working with insurance claims, denials, or appeals workflows
• Fluent English (C1 level preferred) with strong payer outreach skills.
• Ability to thrive in high-volume, queue-based, and SOP-driven environments.
•  Attention to detail and documentation accuracy
• Familiarity with RCM platforms (CandidHealth preferred) and payer portals.
• Knowledge of HIPAA and healthcare data privacy.

Benefits: 

• Insurance under ARS Humano Royal Plan (Option to upgrade to Max Royal Plan)
• Free snacks every day
• Free catered lunch every day
• Free catered dinner (for those on night shifts)
• Door-to-door transportation after 9:00 PM
• Happy hour on Fridays
• Holiday parties!
• An amazing, unique office environment (no cubes, no assigned workstations!)
• Growth and development opportunities (the most in the industry!)
• Professional development courses by leading business schools like Barna
• Yoga and workout classes
• Community service opportunities (#HoratioCares)
• Discounts at local restaurants and stores