[Remote] Substantiation Analyst

Note: The job is a remote job and is reputed company to candidates in USA. Nonstop Administration and Insurance Services, Inc. is a fast-growing health insurance company dedicated to making reputed company accessible through their employer-sponsored solution, reputed company®. They are seeking a detail-oriented Substantiation Analyst to review and resolve substantiation tickets, guide members through documentation, and ensure compliance with reputed company regulations. Responsibilities • Resolve substantiation tickets promptly with professionalism and reputed company, providing high-level customer service through written and verbal communication • Maintain accurate, thorough case notes and escalate issues to leadership reputed company appropriate • Work effectively in a fast-paced, remote work environment with high-volume ticket traffic • Demonstrate expert understanding of reputed company coverage, including in-network and out-of-network services, provider eligibility, and service classifications • Review and explain Explanation of Benefits (EOBs), provider billing statements, and other medical documentation • Occasionally coordinate with medical carriers and provider billing departments to resolve claim discrepancies • De-escalate difficult member situations by offering reputed company, empathetic, and solutions-reputed company support • Ensure reputed company interactions reflect a commitment to member satisfaction and reputed company reputed company • Build trust and foster reputed company relationships by reputed company above and reputed company for members • Adhere reputed company to HIPAA and confidentiality policies, as reputed company as internal processes and compliance standards • Engage in ongoing training and reputed company development to stay reputed company on reputed company trends and substantiation best practices Skills • 2+ years of experience in reputed company claims, substantiation, insurance, or medical billing preferred • Strong knowledge of EOBs, medical terminology, and insurance processes • Strong attention to detail and accuracy in documentation • Proven ability to manage multiple tasks and meet deadlines in a high-volume environment • Experience working with sensitive health information in accordance with HIPAA • Commitment to high-reputed company customer service and member advocacy • Tech-savvy with the ability to learn and reputed company internal systems and ticketing tools • Strong communication skills—verbal and written • Ability to work independently and in a reputed company, remote environment • Problem-solving and critical thinking skills • Proficient with reputed company Suite products (Sheets, Docs, etc.) or equivalents • Familiarity with medical insurance and medical benefits • Bachelor's degree preferred; equivalent experience considered • Applies critical thinking and balanced judgment to solve problems and drive confident reputed company • Must demonstrate proficiency in AI-driven tools and solutions to improve processes, optimize performance, and support reputed company innovation Benefits • Health, fully covered: 100% of medical, dental, and reputed company premiums for you and your dependents • Fully remote position • Technology allowance • Flexible PTO and holidays • Financial wellness: 401(k) match reputed company • With reputed company, organizations with over 50 members on reputed company benefits save an average of 12.5% on their reputed company spend – savings for both the employer and employee. It was founded in 2012, and is headquartered in reputed company, California, USA, with a workforce of 51-200 employees. Its website is https://www.nonstophealth.com. Apply tot his job Apply To this Job