Senior Complex Claims Leader – Medicaid & Subrogation

Assured Benefits Administrators; El Paso (TX); On-site; USD 42,000 - 64,000; Full time

Job summary

Assured Benefits Administrators, Inc. (ABA) is a leading TPA providing healthcare administration solutions across the United States. We are looking for a Claims Processor to ensure accurate year-end processing, handle adjustments, and coordinate benefits.

The role covers Medicaid claims, subrogation, and high-dollar claims, with hospital audits and complex appeals. Ideal candidates have 1–3 years of claims experience and strong attention to detail.

Qualifications

• Associate degree preferred; equivalent combination of education and experience considered.
• Minimum 1–3 years of experience in claims processing.
• Strong understanding of claims processing procedures and medical terminology.
• Detail-oriented with emphasis on accuracy and quality assurance.
• Analytical and problem-solving abilities; able to handle escalated issues.
• Ability to make sound decisions under pressure.

Responsibilities

• Year-End Processing: Oversee year-end processing to close claims records.
• Adjustments: Process adjustments with proper documentation.
• Coordination of Benefits: Manage benefits coordination for claims.
• Subrogation and High-Dollar Claims: Handle complex subrogation/high-dollar cases.
• Medicaid Claims and Complex Appeals: Process Medicaid claims and assist appeals.
• Hospital Audits: Conduct audits to ensure compliance with agreements and regulations.
• Case Management Reports: Analyze reports and file to the correct member.

Skills

Claims processing

Medical terminology

Insurance policies

Data accuracy

Analytical skills

Education

Associate degree

Job description

Assured Benefits Administrators, Inc. (ABA) is a leading TPA providing healthcare administration solutions across the United States. We are looking for a Claims Processor to ensure accurate year-end processing, handle adjustments, and coordinate benefits.

The role covers Medicaid claims, subrogation, and high-dollar claims, with hospital audits and complex appeals. Ideal candidates have 1–3 years of claims experience and strong attention to detail.