Claims Processor - Full-Time

Medical Associates Clinic & Health Plans; Dubuque (IA); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Health insurance

401k matching

Paid time off

Flexible spending accounts

Life insurance

Job summary

Medical Associates Health Plans is seeking a Claims Processor to join our team. You will utilize strong communication skills and collaborate with colleagues to process and pay claims accurately, while managing multiple tasks efficiently.

Ideal candidates have 1–3 years in claims processing and are proficient in Excel. The role requires attention to detail, knowledge of benefit plans, and the ability to interpret plan terms for members and providers. Competitive benefits offered.

Qualifications

• High school diploma or GED required.
• 1–3 years of related claims processing experience.
• Proficient with Microsoft Office applications, particularly Word and Excel.

Responsibilities

• Examine, process, calculate, and pay claims after verification of fee schedules and contract benefits in compliance with state laws, employer contracts, policies and procedures, and production standards established by the company.
• Assist Health Care Services and Subrogation Specialist to ensure timely resolution of claims pended for subrogation and medical authorization.
• Possess knowledge of all health plan benefit plans and provide interpretation to all constituents including potential members, brokers, members, providers, employers, and staff.
• Make appropriate adjustments to previously adjudicated claims.

Skills

Communication

Team collaboration

Multitasking

Claims processing

Excel

Education

High school diploma or GED

Tools

Microsoft Excel

Job description

Medical Associates Health Plans is looking for a Claims Processor to join our team!

The Position:

On a daily basis, this person will utilize their professional oral and written communication skills along with their ability to collaborate successfully with a team. Additionally, a successful person in this role will be organized and efficient at multi-tasking, may have some prior claims processing experience, and be proficient at Microsoft Excel and typing.

Benefits Package Includes:

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing)
• Flexible Paid Time Off Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

What you'll be doing:

• Examine, process, calculate, and pay claims after verification of fee schedules and contract benefits in compliance with state laws, employer contracts, policies and procedures, and production standards established by the company.
• Assist Health Care Services and Subrogation Specialist to ensure timely resolution of claims pended for subrogation and medical authorization.
• Possess knowledge of all health plan benefit plans and provide interpretation to all constituents including potential members, brokers, members, providers, employers, and staff.
• Make appropriate adjustments to previously adjudicated claims.

Knowledge, Skills and Abilities:

Education - High school diploma or GED required.

Experience - One to three years of similar or related experience.

Other Skills - Familiar with Microsoft Office applications, particularly Word and Excel.