We are seeking a detail-oriented Medical Claims Processor I to research and process healthcare benefits claims for inpatient, outpatient, and professional services. This role reviews claims and invoices, applies plan-specific rules, and determines appropriate payment, partial payment, or denial decisions based on client plan documents and claim information.
The position involves analyzing claims in Healthvue360 and HRP systems, maintaining claim records, and ensuring decisions are made accurately and in compliance with applicable laws and client requirements.
Requirements & Qualifications
Required Qualifications
- Experience overseeing processes and workflow of medical claims analysis
- Knowledge of the TPA and health benefits industry
- Strong attention to detail and ability to build operational processes
- Excellent communication, organizational, and leadership skills
- Knowledge of medical terminology and anatomy
- Proficiency with Microsoft Word and Excel
- Ability to multitask and prioritize effectively
- Strong analytical skills and computer system proficiency
- Integrity, ethical conduct, and trustworthiness
- Ability to communicate effectively with internal stakeholders, including senior leaders
Preferred Qualifications
- Bachelor's degree in business administration or a related field
- 5+ years of industry experience working with national and regional healthcare brands
- 5+ years of data entry experience in a high-volume production setting
Benefits & Perks
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Location
Omaha, Nebraska, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
1 week ago
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