Senior Complex Claims Lead — Medicaid & High-Dollar

Independent Medical Systems, Inc.; El Paso (TX); On-site; USD 60,000 - 80,000; Full time

Job summary

Assured Benefits Administrators, Inc. is seeking a Complex Claims Lead in El Paso, TX. The role focuses on processing and closing claims with accuracy, managing year-end tasks, COB, subrogation, Medicaid claims, appeals, and hospital audits.

The ideal candidate has 1–3 years in claims processing, strong knowledge of medical terminology and policies, and proven analytical and escalation-handling abilities to ensure timely resolutions and high-quality outcomes.

Qualifications

• 1–3 years of experience in claims processing or related field.
• Strong understanding of claims processing procedures and medical terminology.
• Attention to detail and quality assurance in claims processing.
• Analytical and problem-solving skills to identify root causes and solutions.
• Experience handling escalated issues and making sound decisions under pressure.

Responsibilities

• Year-End Processing: oversee year-end processing activities for claims closure.
• Adjustments: process adjustments with proper documentation.
• Coordination of Benefits: manage COB for claims.
• Subrogation and High-Dollar Claims: handle complex cases with accuracy.
• Medicaid Claims and Complex Appeals: process Medicaid claims and assist with appeals.
• Hospital Audits: conduct audits to ensure compliance with agreements and regs.
• Case Management Reports: analyze reports and file to the correct member.

Skills

Claims processing

Attention to detail

Analytical thinking

Problem solving

Escalation handling

Education

Associate degree

Job description

Assured Benefits Administrators, Inc. is seeking a Complex Claims Lead in El Paso, TX. The role focuses on processing and closing claims with accuracy, managing year-end tasks, COB, subrogation, Medicaid claims, appeals, and hospital audits.

The ideal candidate has 1–3 years in claims processing, strong knowledge of medical terminology and policies, and proven analytical and escalation-handling abilities to ensure timely resolutions and high-quality outcomes.