Remote Medical Claims Processor Jobs in Carolina, PR

Epic Denials Manager

Position Summary

Join Deloitte's AI & Engineering practice to support hospital billing operations in a role focused on claim accuracy, timely reimbursement, and revenue cycle performance. As an Epic Denials Manager, you will help deliver back-end revenue cycle management (RCM) services, including denials and claims submission, denials management, payment posting, and credits and refunds, A/R follow-up for health care provider client.

Recruiting for this role ends on 10/01/2026.

Work you'll do

Epic Denials Manager on the AI & Engineering team, you will be responsible for the following areas. Oversight and management of claims and denials management follow-up operations. Analyzes, plans and implements organizational systems and processes, and makes recommendations for improvements in hospital denials, claims submission, and A/R follow-up operations. Leads activities related to operational analysis, financial analysis and process improvement initiatives. Maintains knowledge base of operational SOPs and workflows for relevant functional areas. Manages staff and employee performance, provides feedback, and leads training, education, and performance improvement activities for staff as required. Works closely with Manager of Billing and engagement leadership to resolve barriers to account and claim processing and identify and implement opportunity areas to remediate issues and improve workflows. Serves as line of escalation for high priority, complex accounts to be worked, including interactions with third party payers and client stakeholders as necessary to process accounts and claims. Regularly monitors work queues and workflows in Epic, claims clearinghouse, and other relevant technology systems. Collaborates closely with client managers and directors to ensure continuous open communication about hospital operations that impact delivery of services. Works with client team to develop and implement action plan to address trends as appropriate

Keeps current on insurance regulations, managed care contracts billing regulations, coding and fee schedules. Proactively manages access scorecards including user quality, productivity and team performance compared to Key Performance indicators and Service Level Agreements. This is a remote role with minimal travel requirements. A successful candidate would possess these skills:

• Ability to work independently and collaborate as part of a team
• Effective written and verbal communication skills
• Meticulous attention to detail and quality of work product
• Ability to build and sustain professional relationships
• Ability to lead projects or workstreams
• Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
• Strong interpersonal skills and professional demeanor
• Ability to meet deadlines

The team

AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements. Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector.

Qualifications

Required:

• 6+ years of experience as a Manager or Senior in processing and resolving third party payer denials, including technical and clinical denials, for hospital/acute facility services
• 3+ years experience in denials resolution for both commercial and government payers
• Experience leading team of 10+ staff to exceed productivity, quality, and service targets
• Proficient in Epic Resolute Hospital Billing application
• Proficient in Epic Analytics and Reporting applications (e.g., SlicerDicer)
• Bachelor's degree, preferably in information technology, business, or healthcare related field; or equivalent experience
• Limited immigration sponsorship may be available
• Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve
• Role is remote

Preferred:

• Experience using Microsoft Word, Excel, and PowerPoint
• Experience supporting clinical or healthcare business operations
• Experience preparing and delivering technical demonstrations
• Experience analyzing denials workflows, claim issues, or operational data

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $140,000 to $160,000 with overtime pay possible. 

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.

Epic Denials Manager

Position Summary

Join Deloitte's AI & Engineering practice to support hospital billing operations in a role focused on claim accuracy, timely reimbursement, and revenue cycle performance. As an Epic Denials Manager, you will help deliver back-end revenue cycle management (RCM) services, including denials and claims submission, denials management, payment posting, and credits and refunds, A/R follow-up for health care provider client.

Recruiting for this role ends on 10/01/2026.

Work you'll do

Epic Denials Manager on the AI & Engineering team, you will be responsible for the following areas. Oversight and management of claims and denials management follow-up operations. Analyzes, plans and implements organizational systems and processes, and makes recommendations for improvements in hospital denials, claims submission, and A/R follow-up operations. Leads activities related to operational analysis, financial analysis and process improvement initiatives. Maintains knowledge base of operational SOPs and workflows for relevant functional areas. Manages staff and employee performance, provides feedback, and leads training, education, and performance improvement activities for staff as required. Works closely with Manager of Billing and engagement leadership to resolve barriers to account and claim processing and identify and implement opportunity areas to remediate issues and improve workflows. Serves as line of escalation for high priority, complex accounts to be worked, including interactions with third party payers and client stakeholders as necessary to process accounts and claims. Regularly monitors work queues and workflows in Epic, claims clearinghouse, and other relevant technology systems. Collaborates closely with client managers and directors to ensure continuous open communication about hospital operations that impact delivery of services. Works with client team to develop and implement action plan to address trends as appropriate

Keeps current on insurance regulations, managed care contracts billing regulations, coding and fee schedules. Proactively manages access scorecards including user quality, productivity and team performance compared to Key Performance indicators and Service Level Agreements. This is a remote role with minimal travel requirements. A successful candidate would possess these skills:

• Ability to work independently and collaborate as part of a team
• Effective written and verbal communication skills
• Meticulous attention to detail and quality of work product
• Ability to build and sustain professional relationships
• Ability to lead projects or workstreams
• Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
• Strong interpersonal skills and professional demeanor
• Ability to meet deadlines

The team

AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements. Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector.

Qualifications

Required:

• 6+ years of experience as a Manager or Senior in processing and resolving third party payer denials, including technical and clinical denials, for hospital/acute facility services
• 3+ years experience in denials resolution for both commercial and government payers
• Experience leading team of 10+ staff to exceed productivity, quality, and service targets
• Proficient in Epic Resolute Hospital Billing application
• Proficient in Epic Analytics and Reporting applications (e.g., SlicerDicer)
• Bachelor's degree, preferably in information technology, business, or healthcare related field; or equivalent experience
• Limited immigration sponsorship may be available
• Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve
• Role is remote

Preferred:

• Experience using Microsoft Word, Excel, and PowerPoint
• Experience supporting clinical or healthcare business operations
• Experience preparing and delivering technical demonstrations
• Experience analyzing denials workflows, claim issues, or operational data

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $140,000 to $160,000 with overtime pay possible. 

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.