Job Description
Job Description
Our client is seeking a Senior Claims Processor to support a long‐standing benefits organization. This role supports U.S. Benefits, a small, experienced claims processing team within a multi‐employer trust environment. This position is open due to upcoming retirements of senior claims processors and will play a key role in claims processing, auditing, adjudication logic, and knowledge transfer. The ideal candidate has strong medical and/or dental claims experience and is comfortable working in a lower‐volume, high‐accuracy environment.
Responsibilities:
Process medical and/or dental claims across the full lifecycle:
- Intake and review
- Data entry and validation
- Claims adjudication
- Follow‐ups and issue resolution
- Appeals processing
- Final claims resolution
- Audit claims processed by other team members
- Apply adjudication logic and benefit plan rules accurately
- Support claims system configuration and processing logic
- Assist with reporting, data needs, and coding requirements
- Respond to member and provider inquiries via phone and email (moderate volume)
- Collaborate with internal teams to ensure compliance and accuracy
- Maintain detailed documentation and adhere to regulatory requirements
Must‐Have Qualifications:
- 2+ years of medical and/or dental claims processing experience
- 1+ Years of experience with claims adjudication logic and appeals
- 1+ years of experience auditing claims and ensuring compliance
- Familiarity with claims processing systems and configuration tools
- Experience handling customer inquiries via phone and email
- High attention to detail and ability to work independently
- Comfortable working in a small team environment
Company DescriptionAutomation Machinery Manufacturing - Production Team
Company Description
Automation Machinery Manufacturing - Production Team