Union Benefits Medical Claims Specialist

Laborers-Funds-Administrative-Office-of-Northern-California-; Pleasanton (CA); On-site; USD 46,000 - 51,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Pension and Annuity plan

Optional 401K participation

Sick, vacation, holidays under CBA

Job summary

The Laborers Funds Administrative Office of Northern California, Inc. in Pleasanton, CA is hiring a full-time medical Claims Adjuster to process union-negotiated health and welfare claims.

You will interact with members, providers, and vendors to ensure accurate claim handling and clear communication of benefits. The role demands at least two years of medical claims processing and strong customer service skills; bilingual Spanish is preferred.

Qualifications

• Strong organizational and communication skills
• Two years of prior experience in medical claims processing and customer service
• Preferred Bi-lingual in Spanish
• Ability to work independently and within a high-paced, team-oriented environment
• Proficient in MS Suite (Outlook, Excel, Word) and computer systems and applications
• Ability to multi-task, prioritize and meet deadlines
• Self-motivated and remain calm under pressure
• Analytical and detail-oriented with attention to accuracy
• Flexible and adaptable to changes
• Ability to independently research and remain current on medical coding and policy changes
• Discretion with ability to maintain confidentiality
• Strong interpersonal skills in working with employees, members and other departments
• Basic understanding of call center ACD and IVR systems

Responsibilities

• Process medical claims accurately and efficiently.
• Provide excellent customer service by phone and in person to members and their families.
• Communicate policies, regulations, and benefit information clearly.
• Respond to correspondence and inquiries from members, dependents, and providers.
• Collaborate with providers and vendors to resolve claim issues.
• Prepare reports and assist with special tasks and projects related to claims.
• Respond to legal inquiries, including subpoenas, and verify eligibility with network vendors.
• Monitor changes in medical coding and policy updates.

Skills

Organizational skills

Communication skills

Independent work

Multi-tasking

Attention to accuracy

Tools

MS Office

ACD/IVR systems

Job description

The Laborers Funds Administrative Office of Northern California, Inc. in Pleasanton, CA is hiring a full-time medical Claims Adjuster to process union-negotiated health and welfare claims.

You will interact with members, providers, and vendors to ensure accurate claim handling and clear communication of benefits. The role demands at least two years of medical claims processing and strong customer service skills; bilingual Spanish is preferred.