Out-of-Network Medical Claims Specialist

We are seeking a highly motivated and productivity-driven Claims Follow-Up Representative to join our team. This role focuses exclusively on managing and resolving out-of-network (OON) commercial insurance claims. You will be responsible for directly contacting insurance payers to investigate claim statuses, appeal denials, and optimize overall workflow efficiency.

This position requires high-volume phone outreach and meticulous electronic documentation. This is an on-site role in Barranquilla ( Required ) Key Responsibilities High-Volume Claim Management : Manage, review, and work a strict minimum of 75 commercial insurance claims per day. Direct Payer Contact : Conduct phone calls for every single claim to resolve issues directly with insurance payers; portal-only research is insufficient.

Denial Tracking & Escalations : Identify high-dollar claims for prioritization and follow standard protocols for denial follow-ups and payer escalations. Data Documentation : Maintain flawless, real-time documentation of claim actions within our EMR system and shared spreadsheets. Medical Records Assembly : Compile necessary medical records for insurance requests, ensuring no records are sent to payers without internal review and consent.

Requirements

Minimum 6m - 2 years of experience focusing specifically on out-of-network (OON) commercial insurance claims follow-up. Communication Skills : Excellent verbal communication skills with a proven track record of handling high-volume professional phone outreach to insurance payers. Technical Proficiency : Hands-on experience navigating Electronic Medical Record (EMR) systems and working with shared spreadsheets (Excel/Google/Zoho Sheets).

Efficiency : Proven ability to meet strict daily performance, quality, and productivity metrics. Attention to Detail : Sharp organizational skills required for capturing claim reference numbers and assembling medical record packages accurately.