[Remote] Substantiation Analyst

Note: The job is a remote job and is open to candidates in USA. Nonstop Administration and Insurance Services, Inc. is a fast-growing health insurance company dedicated to making healthcare accessible through their employer-sponsored solution, Nonstop Health®. They are seeking a detail-oriented Substantiation Analyst to review and resolve substantiation tickets, guide members through documentation, and ensure compliance with healthcare regulations. 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 Skills • 2+ years of experience in healthcare 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-quality customer service and member advocacy • Tech-savvy with the ability to learn and navigate internal systems and ticketing tools • Strong communication skills—verbal and written • Ability to work independently and in a collaborative, remote environment • Problem-solving and critical thinking skills • Proficient with Google 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 decisions • Must demonstrate proficiency in AI-driven tools and solutions to improve processes, optimize performance, and support continuous innovation Benefits • Health, fully covered: 100% of medical, dental, and vision premiums for you and your dependents • Fully remote position • Technology allowance • Flexible PTO and holidays • Financial wellness: 401(k) match Company Overview • With Nonstop Health, organizations with over 50 members on healthcare benefits save an average of 12.5% on their healthcare spend – savings for both the employer and employee. It was founded in 2012, and is headquartered in Concord, California, USA, with a workforce of 51-200 employees. Its website is Apply tot his job