Medical Claims Processor

Trucordia; Lindon (UT); Remote; USD 40,000 - 55,000; Full time

Job summary

A leading company is seeking an experienced Medical Claims Processor to assist clients with inquiries and ensure high satisfaction levels. The role involves reviewing claims, determining benefits, and maintaining accurate records while collaborating with various departments to ensure compliance and smooth processing.

Benefits

Medical, Dental, Vision

Life and AD&D insurance

FSA / HSA

Commuter & Child Care FSA

Cancer Support Benefits

Pet Insurance

Accident & Critical Illness

Hospital Indemnity

Employee Assistance Program (EAP)

401K

Qualifications

• 1-2 years of experience in medical claims.
• Technical proficiency with insurance systems.
• Thorough understanding of health insurance benefit plans.

Responsibilities

• Review claims for accuracy and compliance.
• Determine reimbursement amounts based on coverage.
• Maintain accurate records of all claims.

Skills

Communication

Interpersonal Skills

Problem Solving

Self-Motivated

Tools

Insurance Agency Management Systems

Dental and Medical Claim Forms

Billing Codes

Job description

Job Description

We are looking for an experienced and dedicated Medical Claims Processor with an understanding of medical insurance benefits and claims processing. As a Medical Claims Processor, you will play a crucial role in assisting clients with inquiries and issues, ensuring high levels of satisfaction and support.

Duties and Responsibilities:

• Claim Review and Processing: Review submitted claims for accuracy, completeness, and compliance with the self-funded plan's policy. Interpreting coding and understanding medical terminology while following adjudication policies and procedures to ensure proper payment of claims.
• Benefit Determination: Determine the amount of reimbursement due based on the plan's coverage and any applicable deductibles or copays.
• Payment Processing: Initiate payment or denial of claims, ensuring timely and accurate disbursement.
• Documentation and Record Keeping: Maintain accurate records of all claims, including supporting documentation and correspondence.
• Communication and Customer Service: Respond to inquiries from policyholders and providers regarding claim status, coverage, and billing.
• Problem Solving: Identify and resolve discrepancies, denials, and other issues related to claims processing. Request overpayments and complete necessary adjustments.
• Data Entry and Maintenance: Update and maintain claim information in electronic databases.
• Collaboration: Work with other departments, such as enrollment and provider relations, to ensure smooth claim processing.
• Compliance: Adhere to all relevant federal and state regulations governing health insurance and claim processing.

Qualifications:
Qualifications

• Remote position open to residents located in Utah.
• 1-2 years of experience in medical claims
• Excellent communication and interpersonal skills.
• Self-motivated, goal-oriented, and able to work independently and as part of a team.
• Technical proficiency with insurance agency management systems.
• Knowledge of Dental and Medical Insurance Claim Forms (ADA2012, HCFA1500, UB04 & Superbill)
• Knowledge of Dental and Medical Billing Codes (CDT, CPT, HCPCS & ICD-10)
• Thorough understanding of health insurance benefit plans.

Additional Information

Please see our company Benefits:

• Medical, Dental, Vision
• Life and AD&D insurance
• FSA / HSA
• Commuter & Child Care FSA
• Cancer Support Benefits
• Pet Insurance
• Accident & Critical Illness
• Hospital Indemnity
• Employee Assistance Program (EAP)
• 11 Paid Holidays
• Flexible PTO
• 401K

Trucordia is an equal opportunity employer. We believe that every employee has the right to work in an environment that is free from all forms of discrimination. It is our policy that all decisions involving any aspect of the employment relationship such as hiring, compensation and training, promotions, transfers, discipline, and termination will be based on merit, qualifications, and abilities. Such decisions will be made without regard to age, ancestry, color, race, national origin, disability, protected medical condition, genetic information, military service, veteran status, citizenship status, religion, creed, sex, gender, gender identity, sexual orientation, pregnancy, childbirth, marital status, or any other condition, characteristic or activity protected by law. Discrimination based on any of these factors is contrary to our operating philosophy. Attention Recruitment Agencies: Trucordia does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered property of Trucordia, and we will not be obligated to pay a referral fee. This includes resumes submitted directly to hiring managers without contacting Trucordia's Talent Acquisition Department.