Nurse - High Volume Claims Call Specialist

Remote Nurse - High Volume Claims Call Specialist

Location: Remote (Work from Home)
Hours: Full-time, 3Pm-11pmSA  (Monday Friday)

Must Reside in South Africa

Overview:
We are seeking a tech-savvy, highly communicative Nurse to join our team as a Claims Call Specialist. You will be responsible for conducting outbound calls to patients recently discharged from hospitals, assessing their post-discharge needs, discussing medication adherence, appointment scheduling, and related care.
All calls are processed through a sophisticated system that automatically records the conversation, generates tasks, applies billing codes, and prepares claims. The focus is on phone communication only no direct nursing or clinical tasks.

Key Responsibilities:

• Conduct high-volume outbound calls to patients discharged from medical facilities.

• Discuss topics such as medication management, follow-up appointments, and general well-being.

• Follow a structured call guide to capture specific information tied to billing codes.

• Meet productivity targets (aiming for 23 completed claims calls per hour).

• Ensure all conversations are clear, empathetic, and professional.

• Use the automated system effectively to ensure accurate task generation and billing preparation.

• Maintain confidentiality and adhere to HIPAA and privacy regulations.

Requirements:

• Active Nursing License (RN, LPN, or LVN) must be current and unrestricted.

• Excellent verbal communication and listening skills.

• Comfortable handling a high volume of structured calls (phone-based role).

• Tech-savvy; able to learn and operate call management and billing software.

• Ability to work independently, stay focused, and meet hourly call/claims targets.

• High attention to detail and strong organizational skills.

• Reliable internet connection, computer, and headset for remote work.

Preferred Experience:

• Previous experience in telehealth, care management, insurance claims, or call center environments is a plus.

• Familiarity with medical coding and billing is an advantage (not required).