Senior Claims Processor

Fcebenefits; San Antonio (TX); On-site; USD 55,000 - 75,000; Full time

Job summary

FCE Benefits Administrators in San Antonio, TX, seeks a Senior Claims Processor (On-site) to oversee adjudication of complex healthcare claims, ensuring accuracy, timeliness, and regulatory compliance.

You will review COB, process HRA claims, mentor staff, and collaborate on special projects while maintaining high quality and productivity standards.

Candidates should have 3–5 years in medical claims processing and knowledge of self-funded plans.

Qualifications

• 3–5 years of medical claims processing experience.
• Experience with HRA administration and complex claims.
• Experience with claims systems and software.
• Knowledge of healthcare benefits and eligibility.
• Attention to detail and accuracy.
• Ability to work on site and meet deadlines.

Responsibilities

• Process healthcare claims per plan provisions, contracts, and guidelines.
• Process HRA claims accurately and efficiently.
• Complete class changes and other claim maintenance.
• Review claims for accuracy, eligibility, COB, and benefits.
• Research and resolve issues to ensure proper adjudication.
• Maintain established quality and productivity standards.
• Assist with training activities and knowledge sharing.
• Maintain compliance with policies, client requirements and regulations.
• Participate in special projects and departmental initiatives.

Skills

Claims processing

HRA administration

Complex claims

Training / mentoring

Regulatory compliance

Quality standards

Education

High school diploma

Associate degree in related field

Healthcare certifications

Tools

Claims processing software

Healthcare benefits systems

Job description

Careers

Career Opportunity with FCE Benefits Administrators

We are seeking an experienced Senior Claims Processor (On-site) to oversee the accurate and timely adjudication of complex healthcare claims. In this advanced role, you will maintain exceptional standards of quality, productivity, and compliance. Beyond standard processing, you will handle a broadrange of specialized claim types, support strategic departmental initiatives, and serve as a mentor by assisting with training activities.

Key Responsibilities:

• Process healthcare claims in accordance with plan provisions, client contracts, and departmental guidelines.
• Process Health Reimbursement Arrangement (HRA) claims accurately and efficiently.
• Complete class changes and other claim-related maintenance functions.
• Review claims for accuracy, eligibility, coordination of benefits, and benefit application.
• Research and resolve claim issues to ensure proper adjudication and payment.
• Maintain established quality and productivity standards.
• Assist with training activities and knowledge-sharing initiatives within the department.
• Maintain compliance with company policies, client requirements, and applicable federal and state regulations.
• Participate in special projects and departmental initiatives as assigned.

Qualifications:

• High school diploma or equivalent required.
• Minimum 3-5 years of medical claims processing experience preferred.
• Experience processing complex medical claims in a self-funded, TPA, insurance carrier, or healthcare environment.
• Experience with HRA administration, claim adjustments, and complex claim scenarios.
• Experience with claims administration systems and claim processing software.
• Knowledge of healthcare benefits, eligibility, claim adjudication, and reimbursement methodologies.

Preferred Skills:

• Associate’s degree or vocational training in a related field, such as medical billing and coding, healthcare administration, or business administration.
• Experience with self-funded employer health plans.
• Medical billing, coding, or insurance-related certifications.

It is FCE Benefit’s policy to provide equal opportunity employment for all qualified applicants and employees. FCE does not unlawfully discriminate on thebasis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), national origin, ancestry, age, physical or mental disability,legally protected medical condition, family care status, veteran status, marital status, sexual orientation, or any other basis protected by state or federal law orlocal ordinance. This applies to all areas of employment including recruitment, hiring, training, promotion, compensation, benefits, transfer, and social andrecreational programs.

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