Medical Claims Processor - Health Insurance
Medical Claims Processor - Health Insurance
Posted on :
27-06-2025
Employer Active
1 Vacancy
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Job Description
A High-End Benefit Provider in Glendale CA. is looking to hire a Claims Customer Service Representative to oversee Medical Dental and Vision claims while providing excellent customer service to participants physicians providers and hospitals. This is a Remote position.
This role is customer facing and you will process health insurance claims and answers calls (heavy phones) while adhering to eligibility claims and call policies and procedures while making sound claim/call decisions.
Essential Job Functions:
You need efficiency accuracy quality customer satisfaction and good attendance
Answer incoming phone calls from customers and identify the type of assistance the customer needs (e.g. benefit and eligibility billing and payment inquiries authorizations for treatment and explanation of benefits (EOBs))
Ask questions and listen actively to identify specific questions or issues while documenting required information
Resolve problems by interpreting and clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; addressing unresolved problems
Review and research incoming healthcare claims by navigating multiple computer systems and platforms
Ensure that the proper benefits are applied to each claim
Qualifications and Education Requirements:
Bachelors Degree in Healthcare preferred Math Engineering or related field
A minimum of an Associates Degree required.
Minimum of four (4) years of claims processing preferred
Minimum of four (4) years in heavy call center required
Learn various software applications and become self-sufficient in using the software in a user interface environment
Demonstrate adaptability and forward-thinking
Strong analytical and interpersonal skills
Proficient with Microsoft products including Word Excel and Outlook
Excellent customer service and telephone skills
Ability to effectively balance workload in a fast-paced work environment
Excellent verbal and written communication skills
Knowledge of medical terminology
Ability to research and verify claims payment benefits and eligibility issues
Strong knowledge of benefits plans policies and procedures
Amazing Benefits Offered
Job Type: Full-time
Pay: $55000.00 - $62000.00 per year
Equal Opportunity Employer considering qualified applicants in accordance with applicable state and federal laws. Qualified applicants with arrest or conviction records will be considered for employment in accordance with the LA County Fair Chance Ordinance the City of Los Angeles Fair Chance Initiative for Hiring Ordinance and state law.
This role is customer facing and you will process health insurance claims and answers calls (heavy phones) while adhering to eligibility claims and call policies and procedures while making sound claim/call decisions.
Essential Job Functions:
You need efficiency accuracy quality customer satisfaction and good attendance
Answer incoming phone calls from customers and identify the type of assistance the customer needs (e.g. benefit and eligibility billing and payment inquiries authorizations for treatment and explanation of benefits (EOBs))
Ask questions and listen actively to identify specific questions or issues while documenting required information
Resolve problems by interpreting and clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; addressing unresolved problems
Review and research incoming healthcare claims by navigating multiple computer systems and platforms
Ensure that the proper benefits are applied to each claim
Qualifications and Education Requirements:
Bachelors Degree in Healthcare preferred Math Engineering or related field
A minimum of an Associates Degree required.
Minimum of four (4) years of claims processing preferred
Minimum of four (4) years in heavy call center required
Learn various software applications and become self-sufficient in using the software in a user interface environment
Demonstrate adaptability and forward-thinking
Strong analytical and interpersonal skills
Proficient with Microsoft products including Word Excel and Outlook
Excellent customer service and telephone skills
Ability to effectively balance workload in a fast-paced work environment
Excellent verbal and written communication skills
Knowledge of medical terminology
Ability to research and verify claims payment benefits and eligibility issues
Strong knowledge of benefits plans policies and procedures
Amazing Benefits Offered
- Employer paid Medical Dental and vision Insurance - $50 a month for Dependents up to 5 people
- 401K with 2% match
- Employees receive a Pension for Retirement!!
- Paid Parking
- Generous Vacation Pay- 12 days in first year - up to 25 days after 10 years of employment
- Sick Pay- 12 days a year
- 2 Floating Holidays
- Anniversary of your start date off every year
Job Type: Full-time
Pay: $55000.00 - $62000.00 per year
Equal Opportunity Employer considering qualified applicants in accordance with applicable state and federal laws. Qualified applicants with arrest or conviction records will be considered for employment in accordance with the LA County Fair Chance Ordinance the City of Los Angeles Fair Chance Initiative for Hiring Ordinance and state law.
Employment Type
Full-Time
Key Skills
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