Medical Claims Processor

The Line Construction Benefit Fund, commonly known as LINECO, was founded in 1963 and is a self-funded, self-administered health and welfare plan that provides a comprehensive suite of benefits to IBEW and NECA members working in the outside electrical construction industry. LINECO offers a full range of medical benefits, including prescription drug coverage, dental benefits, vision, short term disability, life insurance, and behavioral health support designed to provide members with the best care available at a predictable cost.

At LINECO, we are providing our members with best in class service, and if you are mission driven and passionate about healthcare and claims processing, we would love to connect with you.

Our
Claims Team
is a vital part of our organization here at LINECO. They are responsible for the insurance claims process, verifying coverage, assessing claim details, and facilitating the payment or resolution of claims. As part of the
Claims Team
, the
Claims Processor
is responsible for processing both electronic and paper medical, dental and Health Reimbursement Account (HRA) claims in a professional and objective manner based on LINECO's benefits plan. You are crucial for ensuring our claims are handled efficiently, accurately, and fairly.

This is a full-time, hourly (non-exempt) position, the hourly range for this role is $25.00 to $27.00 depending on level of experience.

You're excited about this opportunity because you will…

• Analyze insurance medical, dental, and HRA claims for accuracy, completeness, and adherence to LINECO benefits plan and guidelines
• Accurately input claims information into the claims processing software program
• Interact with claimants, policyholders, and other parties to gather information, conduct research, answer questions, and resolve issues
• Maintain detailed records of claims activity and processing steps
• Determine the validity of claims and process them for payment or denial
• Ensure that claims are processed in accordance with relevant regulations and company policies
• Identify and resolve discrepancies or issues related to claims
• Work well with others within the framework of the claims processing team.
• Have the ability to spend around 95% of your daily work time on a computer and within the claims processing software programs

We're excited about you because…

• High school diploma OR GED
• 1+ years of medical and dental claims processing experience
• At least 1 year of Blue Cross/Blue Shield medical insurance claims processing experience
• Experience working with dental inquiries, medical terminology, prescription drug protocol, Medicare, union bargained benefits and HRA regulations
• Data entry and/or typing experience, at least 40 WPM
• Proficiency in using computer systems, databases, and other relevant software
• Strong interpersonal, verbal and written communication skills
• Strong analytical and organizational skills and independent decision-making skills with the ability to learn quickly and adapt to change
• Ability to spend approximately 95% of the scheduled time on a computer according to business needs and sit for long periods of time (standing desks are provided)
• Experience working with Google Suite, Microsoft Office Suite, and claims processing software

You'll love working with us because…

• We are hard working, mission driven organization who prides ourselves on providing quality service to our members
• We are people-centric. Our team consists of employees with long tenures, and we foster engagement and appreciation with our employees
• We are humble, compassionate, and empathetic and let this guide our mission and values
• Very strong benefits package which includes medical coverage, dental, vision, prescription drug, disability, and pension plan and annuity plan for retirement
• Competitive salaries/hourly rates, referral and spot bonuses when applicable
• Comprehensive time-off plan including vacation, sick, and personal (PLAWA) time
• Collaborative, team oriented work environment with Hybrid schedule (following new hire training period)
• Fun and engaging culture driven by our employee committee with monthly activities