Claims Processor: Medicaid, High-Dollar Claims & Audits

National Healthcare Solutions Group LLC; El Paso (TX); On-site; USD 42,000 - 56,000; Full time

Job summary

Assured Benefits Administrators, Inc. in El Paso, TX is seeking a Claims Processor to support efficient claims processing and ensure accuracy across year-end activities, COB and Medicaid related tasks.

The role emphasizes attention to detail and strong analytical ability in a healthcare payer environment. Ideal candidates have 1–3 years of claims processing experience, familiarity with medical terminology, and the capacity to handle escalations with sound judgment in a fast-paced setting.

Qualifications

• Bachelor's degree preferred, experience considered in lieu of degree.
• 1–3 years of experience in claims processing or related field.
• Strong understanding of claims processing procedures.
• Highly detail-oriented with a focus on accuracy and quality assurance in claims processing.
• Experience handling escalated issues and making sound decisions under pressure.

Responsibilities

• Year-End Processing: Oversee year-end processing activities for timely, accurate claims closure.
• Adjustments Management: Process adjustments with proper documentation.
• Coordination of Benefits: Manage coordination of benefits for claims.
• Subrogation and High-Dollar Claims: Handle subrogation and high-dollar claims with attention to detail.
• Medicaid Claims and Complex Appeals: Process Medicaid claims and assist in complex appeals.
• Hospital Audits: Conduct audits to ensure compliance with agreements and regulations.
• Case Management Reports: Analyze reports and ensure correct filing for each member.

Skills

Claims processing

Medical terminology

Attention to detail

Analytical skills

Problem solving

Escalation handling

Education

Bachelor's degree preferred

Job description

Assured Benefits Administrators, Inc. in El Paso, TX is seeking a Claims Processor to support efficient claims processing and ensure accuracy across year-end activities, COB and Medicaid related tasks.

The role emphasizes attention to detail and strong analytical ability in a healthcare payer environment. Ideal candidates have 1–3 years of claims processing experience, familiarity with medical terminology, and the capacity to handle escalations with sound judgment in a fast-paced setting.