Medical Claims Processor

22 hours ago


St Louis, Missouri, United States TEKsystems Full time
Medical Claims Processor Job Description

We are seeking a highly skilled Medical Claims Processor to join our team at TEKsystems. As a Medical Claims Processor, you will be responsible for reviewing and analyzing medical claims for eligibility and benefits, as well as adjudicating claims per the Fund's benefit plan.

Key Responsibilities:
  • Work closely with peers to ensure the goals and duties of the Claims Department are met efficiently, accurately, and pleasantly.
  • Review and analyze medical claims for eligibility and benefits.
  • Adjudicate medical claims per the Fund's benefit plan.
  • Maintain knowledge of all Fund benefits.
  • Provide excellent customer service to claimants and providers.
  • Manage inbound calls from members to verify eligibility and coordinate non-emergent transportation.
  • Listen and obtain information from callers in a professional, systematic, and organized manner.
  • Acquire and maintain in-depth knowledge of, and adhere to, established Protocols and Procedures.
  • Assume responsibility for self-development and career progression.
  • Maintain flexibility in efforts to provide quality service to our members and help achieve business and operational goals.
Requirements:
  • High School graduate or GED equivalent.
  • 2+ years of medical billing or collections experience.
  • Working knowledge of healthcare industry, insurance claims, and associated medical terminology.
  • Strong customer service aptitude.
  • Working knowledge of Microsoft Office and Adobe Acrobat products.
  • Strong communication skills.
Benefits:
  • Medical, dental, and vision benefits.
  • Critical Illness, Accident, and Hospital benefits.
  • 401(k) Retirement Plan.
  • Life Insurance (Voluntary Life & AD&D for the employee and dependents).
  • Short and long-term disability benefits.
  • Health Spending Account (HSA).
  • Transportation benefits.
  • Employee Assistance Program.
  • Time Off/Leave (PTO, Vacation or Sick Leave).


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