Telephone triage nurses

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 2-3 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).

Originally posted on Himalayas