Medical Insurance Denials & Claims Follow-Up Specialist in Randburg, Northern Cape at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Medical Insurance Denials & Claims Follow-Up Specialist based in South Africa.

As a Medical Insurance Denials & Claims Follow-Up Specialist, you will play a critical role in ensuring outstanding healthcare claims are investigated, followed up, and resolved efficiently. You will review medical billing records and denial reports, identify the reasons behind unpaid or underpaid claims, and work directly with insurance providers to resolve issues. This is a detail-oriented role that requires persistence, strong organization, and consistent ownership of open claims. You will help maintain accurate claim records, identify recurring billing and denial trends, and ensure necessary corrections are made promptly. Working remotely with a US-based healthcare operation, you will collaborate with internal stakeholders while managing priorities independently. Your work will directly contribute to stronger revenue cycle performance and fewer unresolved insurance claims.

• Review medical billing records, outstanding claims, payment information, and insurance denial reports to identify claims requiring action.
• Investigate denied, rejected, underpaid, and unpaid claims to determine the underlying reason for non-payment and identify the appropriate resolution.
• Contact insurance companies and relevant representatives to obtain claim status updates, clarify payment decisions, and determine what information or documentation is required.
• Follow up consistently on outstanding claims until they are resolved, ensuring that no claim or action item is left unattended.
• Identify missing information, billing errors, coding issues, documentation gaps, or other corrections required to move claims toward payment.
• Correct and resubmit claims when appropriate, following applicable billing and payer requirements.
• Maintain detailed and accurate records of all claim activity, communications, follow-up dates, payer responses, and resolution steps.
• Track claims throughout the full resolution process and maintain clear visibility into outstanding items and next actions.
• Identify recurring denial patterns, payer issues, or billing problems and communicate relevant trends to internal stakeholders.
• Escalate complex, high-priority, or recurring issues when additional intervention is required.
• Provide clear and timely updates on claim status, challenges, and resolutions to relevant internal teams.
• Manage multiple claims and competing priorities while maintaining accuracy, consistency, and reliable follow-through.

• You have previous experience in medical billing, medical claims, health insurance, revenue cycle management, or a closely related healthcare administration environment.
• Experience working with US healthcare insurance providers and claims processes is strongly advantageous.
• You have excellent organizational and administrative skills, with the ability to manage a high volume of outstanding claims and follow-up activities.
• You demonstrate exceptional attention to detail and accuracy when reviewing billing information, claim records, payer responses, and supporting documentation.
• You are persistent and confident when communicating with insurance providers and are comfortable following up repeatedly until an issue reaches resolution.
• You bring strong investigative and problem-solving skills, with the ability to identify why a claim was denied or unpaid and determine the appropriate next step.
• You communicate professionally and courteously with insurance representatives, colleagues, and other stakeholders.
• You maintain detailed, accurate, and well-organized records of claim activity and follow-up efforts.
• You have strong written and verbal English communication skills suitable for working with US-based healthcare stakeholders.
• You can prioritize multiple outstanding claims while meeting deadlines and maintaining a high standard of accuracy.
• You are comfortable working independently in a remote environment with minimal supervision.
• You demonstrate strong ownership, reliability, accountability, and follow-through, ensuring that outstanding issues are actively managed until resolved.

• Fully remote, work-from-home position based in South Africa.
• Full-time opportunity with a consistent Monday-to-Friday schedule.
• Working hours aligned with US business hours, from 9:00 AM to 5:00 PM EST.
• Salary paid in South African Rand (ZAR).
• Opportunity to support a US-based healthcare operation and gain exposure to medical insurance and revenue cycle processes.
• Independent working environment with responsibility for managing claims and follow-up activities.
• Opportunity to contribute directly to improving claims resolution, payment recovery, and operational efficiency.