Claims Technician ALBUQUERQUE

Health Care Service Corp.; Albuquerque (NM); On-site; USD 24,000 - 36,000; Full time

Job summary

Health Care Service Corporation in Albuquerque, NM is seeking a Claims Technician responsible for processing complex healthcare claims, coordinating benefits, and resolving denials. You will review, adjudicate, and ensure accurate service in line with policies and regulations, including HIPAA compliance.

The role starts at $17.75 per hour with mandatory onsite training (Mon-Fri, 8am-5pm). After training, a work-from-home arrangement is considered based on performance.

Qualifications

• High School diploma OR GED.
• Solid data entry and/or typing experience.
• Proficiency in Microsoft Office Suite, including Excel for data review and reporting.
• Clear and concise written and verbal communication skills.
• Experience processing medical claims with the ability to manage high-volume workloads while maintaining quality metrics.
• Strong attention to detail, problem-solving, and organizational skills.

Responsibilities

• Process complex claims in various queues.
• Conduct research and investigation into missing information, phone providers as necessary, access materials to process and adjudicate timely.
• Resolve complex pended claims, duplicate claims and adjustments.
• Process claims involving communications with participating plans and/or Service Units.
• Research and identify other insurance, Medicare, Medicaid and update patient file as needed.
• Coordinate benefits; request explanation of benefits as needed.
• Maintain knowledge of medical terminology and CPT, HCPCS, and ICD9 coding.
• Learn and maintain knowledge of DOL ERISA and prompt pay legislation.

Skills

Attention to detail

Analytical skills

Clear communication

High-volume workloads

Problem-solving

Education

High School diploma or GED

Tools

Microsoft Office

Excel

IMAGE system

Financial Suspense System (FSS)

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary BASIC FUNCTION Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits and resolving pended claims. The Claim Technician is responsible for reviewing, processing, and adjudicating healthcare claims accurately and efficiently in accordance with company policies, payer guidelines, and regulatory requirements. This role investigates claim discrepancies, researches denials, verifies member and provider information, and ensures timely claim resolution. The Claims Technician also collaborates with internal departments, providers, and members to resolve claim issues while maintaining high standards of accuracy, productivity, compliance, and customer service.

The ideal candidate demonstrates strong analytical skills, attention to detail, and knowledge of healthcare claims processing, medical terminology, and applicable regulations, including HIPAA.

Starting pay will start at $17.75 and the role will be based out of Albuquerque NM. NOTE: there is mandatory onsite training with strict attendance requirements which occurs Monday-Friday (8am to 5pm). Upon successful completion of the required training, work from home provisions will be established.

JOB REQUIREMENTS

• High School diploma OR GED.
• Solid data entry and/or typing experience.
• Proficiency in Microsoft Office Suite, including Excel for data review and reporting.
• Clear and concise written and verbal communication skills.
• Experience processing medical claims with the ability to manage high-volume workloads while maintaining quality metrics.
• Strong attention to detail, problem-solving, and organizational skills.

PREFERRED REQUIREMENTS

• Must have trained on the six or eight-week Blue Chip claims processing system or have the ability to fully complete the six or eight-week Blue Chip Training class.
• Knowledge of medical terminology and CPT, HCPCS, and ICD9 coding.
• Knowledge of coordination of benefits principles and terminology.
• Familiarity with claims adjudication systems and healthcare payer processes.
• Experience with multi-tasking and prioritizing.

KEY FUNCTIONS

• Process complex claims in various queues.
• Conduct research and investigation into missing information, make phone calls to providers (as necessary), access resource materials and support files in order to process and adjudicate claims timely and accurately.
• Resolve complex pended claims, duplicate claims and adjustments.
• Process claims, involving communications with participating plans and/or Service Units. Resolve various issues.
• Research and identify other insurance, Medicare, Medicaid and update patient file as needed.
• Coordinate benefits; request explanation of benefits as needed.
• Maintain a working understanding of medical terminology and CPT, HCPCS, and ICD9 coding.
• Maintain knowledge related to specific contracts.
• Read appropriate files in IMAGE and apply information to claims as needed using the Financial Suspense System (FSS).
• Learn and maintain knowledge of DOL ERISA and prompt pay legislation.
• Periodic overtime may be required at the sole discretion of the employer based on business need.

Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. This position requires on-site training with the ability to return for onsite training for up to 18 months at a designated Customer Service Hub.

Customer Service employees hired at and assigned to a Customer Service Hub location must live near one of the designated Customer Service Hubs. Customer Service Hubs are located in HCSC’s six (6) state Headquarters (Illinois, Montana, New Mexico, Oklahoma, Tennessee and Texas) and in the following locations: Morgan Park, Pilsen, Springfield and Houston.

HCSC Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range $17.75 - $26.17 Exact compensation may vary based on skills, experience, and location.

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.