Substantiation Analyst

Who We Are:

Nonstop Administration and Insurance Services, Inc. is a fast-growing health insurance organization with a firm belief that everyone should have access to high-quality, affordable healthcare. We offer an employer-sponsored group health insurance solution called Nonstop Wellness to achieve this goal.

What Nonstop is Looking For:

We are seeking a detail-oriented, empathetic, and knowledgeable  Substantiation Agent to join our team. In this role, you will review and resolve substantiation tickets, guide members through the documentation process, and ensure compliance with healthcare regulations and company policies. Your work will directly impact the member experience, so a passion for service and a deep understanding of medical insurance claims and billing is key

Primary Responsibilities

• Resolve substantiation tickets promptly with professionalism and clarity, providing high-level customer service through written and verbal communication
• Maintain accurate, thorough case notes and escalate issues to leadership when appropriate
• Work effectively in a fast-paced, remote work environment with high-volume ticket traffic
• Demonstrate expert understanding of healthcare 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 calm, empathetic, and solutions-focused support
• Ensure all interactions reflect a commitment to member satisfaction and positive outcomes
• Build trust and foster positive relationships by going above and beyond for members
• Adhere strictly to HIPAA and confidentiality policies, as well as internal processes and compliance standards
• Engage in ongoing training and professional development to stay current on healthcare trends and substantiation best practices
  

Qualifications

• 2+ years of experience in healthcare claims, substantiation, insurance, or medical billing preferred
• Strong knowledge of EOBs, medical terminology, and insurance processes
• Excellent written and verbal communication skills
• 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-quality customer service and member advocacy
• Tech-savvy with the ability to learn and navigate internal systems and ticketing tools

Preferred Skills and Experience:

• Proficient with Google Suite products (Sheets, Docs, etc.) or equivalents
• Familiarity with medical insurance and medical benefits 

Physical Requirements: 

• Prolonged periods sitting at a desk and working on a computer per day
• Repetitive use of fingers, hands, elbows, arms including typing, reaching, grasping, and writing
• Ability to lift, carry, push, pull, and carry 5-30 pounds occasionally
• Hearing and speaking ability sufficient to carry on a conversation with another individual (or groups of individuals) in person and over the telephone
• Visual ability sufficient to read and produce printed material and information displayed on a computer screen

Perks and Compensation:

• Full-time / Non-exempt / Hourly Position 
• Hourly Rate $28.85 hr
• Internet Reimbursement
• Fully Remote Position (Virtual / Work From Home)
• Monday - Friday schedule with No Weekends!!
• 401(k) plan participation with employer-matched contributions
• Full medical, dental, and vision benefits with 100% employer-paid premiums after the introductory period is met
• Voluntary Benefits offered for employees and dependents

Nonstop provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.