Senior Complex Claims Lead

National Healthcare Solutions, Inc.; El Paso (TX); On-site; USD 42,000 - 60,000; Full time

Job summary

Assured Benefits Administrators, Inc. in El Paso, TX is seeking a Complex Claims Lead to oversee claims processing tasks across year-end activities, adjustments, COB, subrogation, Medicaid claims, and complex appeals.

The role emphasizes accuracy, attention to detail, and the ability to manage high-dollar cases, conduct hospital audits, and analyze case management reports to ensure proper filing and compliance.

Qualifications

• Associate degree preferred; equivalent combination of education and experience considered.
• 1–3 years of experience in claims processing or related field.
• Strong understanding of claims processing procedures and medical terminology.
• Detail-oriented with focus on accuracy and quality assurance in claims processing.
• Strong analytical and problem-solving skills; able to identify root causes and develop solutions.
• Experience handling escalated issues and making decisions under pressure.

Responsibilities

• Year-End Processing: Oversee and facilitate year-end processing activities for claims.
• 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 to ensure compliance with agreements and regulations.
• Case Management Reports: Analyze case management reports and ensure correct filing for members.

Skills

Claims processing

Attention to detail

Analytical skills

Problem solving

Escalated issues handling

Education

Associate degree or equivalent

Job description

Assured Benefits Administrators, Inc. in El Paso, TX is seeking a Complex Claims Lead to oversee claims processing tasks across year-end activities, adjustments, COB, subrogation, Medicaid claims, and complex appeals.

The role emphasizes accuracy, attention to detail, and the ability to manage high-dollar cases, conduct hospital audits, and analyze case management reports to ensure proper filing and compliance.