Remote Medical Claims Analyst — Hybrid Role

Prairie States Enterprises, Inc.; Sheboygan (WI); Hybrid; USD 42,000 - 62,000; Full time

Benefits offered by this job

Competitive compensation based on经验

Comprehensive benefits (Medical,Dental

401k with match

Wellness program

Job summary

Prairie States Enterprises, Inc. is seeking a Medical Claims Analyst for a full-time, hybrid/remote role based in Sheboygan, WI. The position includes initial in-person training for 2–3 months with subsequent hybrid remote work.

Typical schedule is Monday–Friday, 8:30 AM–4:30 PM, with no weekends or on-call rotations. The role covers adjudication of medical, dental, and vision claims, interpreting coding in relation to diagnoses and procedures.

Qualifications

• High School Diploma or GED required. Post HS education in medical field and medical terminology highly preferred.
• Experience – 1 to 3 years experience in an insurance or medical office setting strongly preferred.
• Strong customer service and communication skills required.

Responsibilities

• Provides claims adjudication services by reviewing, researching, investigating and processing claims for assigned relationships.
• Provides high-level customer service when interacting with members, Human Resource contacts, employees, providers, and internal staff.
• Reads and comprehends instructions and drafts short correspondence, and memos; presents information in one-on-one and small group situations to customers, clients, and other employees of the organization.
• Understands all aspects of plan documents for assigned groups.
• Demonstrates understanding of electronic claims from exceptions to pass-through audits; identify potential large claims and understand the stop-loss process and pend claims appropriately.
• Performs daily duties and processes claims with minimal direction.
• Responsible for the accurate and timely entry of claims data; high quality data entry in accordance with policies.
• Meets standards for productivity and quality; turnover times for clean claims and timelines for complex claims.
• Assists in answering overflow of outside phone calls, directing the call to the appropriate person.
• Other Claims Dept duties and special projects as assigned.

Job description

Prairie States Enterprises, Inc. is seeking a Medical Claims Analyst for a full-time, hybrid/remote role based in Sheboygan, WI. The position includes initial in-person training for 2–3 months with subsequent hybrid remote work.

Typical schedule is Monday–Friday, 8:30 AM–4:30 PM, with no weekends or on-call rotations. The role covers adjudication of medical, dental, and vision claims, interpreting coding in relation to diagnoses and procedures.