Claims Processing Specialist - Medicaid & High-Dollar Claims

Independent Medical Systems, Inc.; El Paso (TX); On-site; USD 42,000 - 60,000; Full time

Job summary

Assured Benefits Administrators, Inc. (ABA) seeks a Claims Processor in El Paso, TX to ensure accurate and efficient processing of medical claims across programs.

You will handle year-end processing, adjustments, benefits coordination, Medicaid claims, subrogation, and high-dollar cases while maintaining quality and regulatory compliance. The role requires 1–3 years in claims processing, strong attention to detail, and solid knowledge of medical terminology and insurance policies.

Qualifications

• Year-End Processing: Oversee year-end processing of claims records.
• Adjustments Management: Process adjustments with proper documentation.
• Coordination of Benefits: Manage benefits coordination for claims.
• Subrogation and High-Dollar Claims: Handle complex cases with accuracy.
• Medicaid Claims and Complex Appeals: Process Medicaid claims and appeals.
• Hospital Audits: Conduct audits to ensure regulatory compliance.
• Case Management Reports: Analyze and file reports to members.

Responsibilities

• Year-End Processing: Oversee and facilitate year-end processing activities to ensure timely closure of claims.
• Adjustments Management: Process adjustments to claims with proper documentation.
• Coordination of Benefits: Manage coordination of benefits for claims.
• Subrogation and High-Dollar Claims: Handle subrogation and high-dollar claims with care.
• Medicaid Claims and Complex Appeals: Process Medicaid claims and assist in complex appeals.
• Hospital Audits: Conduct hospital audits for contractual and regulatory compliance.
• Case Management Reports: Analyze case management reports and file to the correct member.

Skills

Attention to detail

Analytical thinking

Problem-solving

Medical terminology

Insurance policies

Escalation handling

Education

Associate degree or equivalent

Job description

Assured Benefits Administrators, Inc. (ABA) seeks a Claims Processor in El Paso, TX to ensure accurate and efficient processing of medical claims across programs.

You will handle year-end processing, adjustments, benefits coordination, Medicaid claims, subrogation, and high-dollar cases while maintaining quality and regulatory compliance. The role requires 1–3 years in claims processing, strong attention to detail, and solid knowledge of medical terminology and insurance policies.