Senior Claims Lead: Complex Medical Claims & Audits

Assured Benefits Administrators, Inc.; El Paso (TX); On-site; USD 52,000 - 68,000; Full time

Job summary

Assured Benefits Administrators, Inc. in El Paso, TX seeks a Complex Claims Lead to oversee year-end processing, adjustments, COB, subrogation, Medicaid claims, and hospital audits within a compliant claims operation.

The role emphasizes accuracy, analytical problem-solving, and decision-making under pressure, with 1–3 years of claims processing experience and an associate degree preferred.

Qualifications

• Associate degree preferred; equivalent combination of education and experience considered.
• Minimum of 1–3 years of experience in claims processing or related field.
• Strong attention to detail and analytic skills for complex claims.

Responsibilities

• Year-End Processing: Oversee and facilitate year-end processing activities.
• Adjustments Management: Process adjustments to claims 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 hospital audits for contractual and regulatory compliance.
• Case Management Reports: Analyze reports and ensure proper filing for members.

Skills

Claims processing experience

Attention to detail

Analytical problem-solving

Education

Associate degree

Job description

Assured Benefits Administrators, Inc. in El Paso, TX seeks a Complex Claims Lead to oversee year-end processing, adjustments, COB, subrogation, Medicaid claims, and hospital audits within a compliant claims operation.

The role emphasizes accuracy, analytical problem-solving, and decision-making under pressure, with 1–3 years of claims processing experience and an associate degree preferred.