Claims Processor I

About the Role

The Claims Processor is responsible for accurately reviewing, validating, and entering medical claims information in accordance with Sidecar Health policies and processing guidelines. This role ensures claim completeness, identifies discrepancies, and escalates complex or unusual cases appropriately while maintaining high standards for productivity, quality, and compliance. The Claims Processor documents all activity thoroughly within internal systems, adheres to established workflows, and consistently meets performance expectations in a metrics-driven environment.

This role is ideal for someone who thrives in a fast-paced environment, enjoys organization and accuracy, and takes pride in getting the details right.

Job Responsibilities

• Identify and enter basic procedure codes, diagnosis codes, and claims information as required
• Validate claim data for completeness and follow up on missing or unclear information
• Review claim documentation to ensure it aligns with Sidecar Health policies and processing rules
• Flag discrepancies or unusual information to senior processors or supervisors for further review
• Adhere to productivity, quality, efficiency, and attendance expectations
• Maintain accurate work records, notes, and documentation within claims systems
• Follow established workflows and escalate issues when needed
• Participate in training sessions to build knowledge, system proficiency, and claims processing skills
• Collaborate with peers in huddles, sharing questions, blockers, and process insights
• Provide feedback on claim processing instructions and help identify opportunities to simplify or improve workflows
• Uphold confidentiality and compliance requirements, including HIPAA
• Support special projects, seasonal workflows, or cross-functional initiatives as assigned
• Review internal audit results and take corrective steps to improve accuracy and prevent future errors

Requirements

• 3+ years of experience in claims processing, medical billing, healthcare administration, or a related operational role (or equivalent experience in a regulated, process-driven production environment)
• Experience working in high-production environments where output, idle time, and quality metrics are monitored, and performance is transparent
• Strong sense of ownership and accountability - takes responsibility for outcomes, follows claims through resolution, and does not rely on transferring work to avoid errors or complexity
• Member-first mindset, recognizing that claim accuracy, turnaround time, and responsible ownership directly affect members’ access to care and financial wellbeing
• Ability to manage multiple claims simultaneously while meeting defined service-level agreements (SLAs)
• Strong analytical skills with the ability to identify discrepancies, investigate root causes, and apply policy accurately rather than processing transactions mechanically
• Proficiency navigating multiple systems and tools simultaneously, with the ability to learn new platforms quickly
• High level of professionalism