Medical Insurance Specialist

Title: Medical Insurance Specialist
Division Name: Student Affairs
Department: Health Services

Job Summary

Performs claims adjudication to ensure efficient claims operation in accordance with the Third Party Payer and Business Associate agreements between the Student Insurance office and the current underwriter of the student plan. Provides in-person service to students. Dispenses policy information claims advice procedural information and provides guidance in benefit decisions to students families medical providers and other University personnel.

Additional Information

University Benefit Highlights:

- Insurance benefits including health dental vision and life
- Retirement and supplemental retirement planning options
- Tuition waiver benefits available to staff as well as their eligible dependents
- Paid holiday/administrative closures during Thanksgiving and Winter Breaks
- Paid benefit time

Additional University Benefit information including information regarding eligibility to participate in the State Universities Retirement System and the State of Illinois Group Insurance program can be reviewed here: Rate / Pay Rate

$20.11 - $23.00 per hour

Required Qualifications

1. Any one or combination totaling two (2) years (24 months) from the categories below:
A. College coursework in a health-related field business administration/management human resource management or closely related fields as measured by the following conversion table or its proportional equivalent:
- 30 semester hours equals one (1) year (12 months)
- Associates Degree (60 semester hours) equals eighteen months (18 months)
- 90 semester hours equals two (2) years (24 months)
B. Work experience in a healthcare environment working independently with medical claims denials rejections referrals and prior authorizations.

Preferred Qualifications

1. Familiarity with policy benefits exclusions contract requirements and with methods for resolving disputes and meeting unique needs.
2. Must know insurance carrier and office policies for processing claims enrollment eligibility insurance and medical terminology and insurance principles.
3. Excellent communication skills are necessary.
4. Must be able to compose correspondence which explains or responds to complex questions about claims or the Student Insurance program.
5. Must comprehend medical terminology.
6. Must be able to recognize errors of understanding and provide clarification using initiative tact and judgement.
7. Work on own initiative in accomplishing assigned tasks.

Work Hours

8am to 4:30pm Monday through Friday

Functional Expectations

Must be able to complete the following with or without a reasonable accommodation:

1. Remain at a workstation for extended periods
2. Move about in various locations across campus as needed to complete day-to-day work.
3. Effectively communicate on a daily basis.

Proposed Starting Date

September 2025

Required Applicant Documents

Resume
Cover Letter
Reference List

Please Note: These documents are required to be submitted online in order to complete the application process. Please have these documents ready prior to clicking on Apply

Optional Applicant Documents

Transcripts - See Special Instructions section for additional options
Related Certifications (i.e. Certified Professional Coder (CPC); Certified Coding Specialist (CCS) Registered Health Information Technician (RHIT) or National Healthcareer NHA)s Billing and Coding Specialist (CBCS).
Certification of Retirement Annuity

Please Note: These documents may be submitted online in order to complete the application process. Please have these documents ready prior to clicking on Apply

Special Instructions for Applicants

Please fully complete the entire application including but not limited to the education and work history portions. Be specific on your work history including employment dates (if part-time you must list the number of work hours) and duties for all positions held. Applicable part-time work experience will be considered toward qualifying for this position; however it will be converted to a full-time equivalency to determine combined length of experience. Please do not put see resume in the duties and responsibilities section of the work history. This will be considered an incomplete application and incomplete applications will not be considered.

If you are using college or university coursework to qualify for this position then transcripts (may be unofficial) must be submitted prior to the application deadline to receive full consideration. Transcripts can either be uploaded with your application or submitted via the options listed below.

A copy of any related certifications (i.e. Certified Professional Coder (CPC); Certified Coding Specialist (CCS) Registered Health Information Technician (RHIT) or National Healthcareer NHA)s Billing and Coding Specialist (CBCS) must be submitted prior to the application deadline to receive maximum eligible points on the exam. This copy can either be uploaded with your application or submitted via the options listed below.

To be eligible for Veterans Preference points on the exam appropriate military service documentation such as a DD-214 must be submitted prior to the application deadline.

Fax: 309.438.0011 Attn: Mackenzie Chapman
Address: Illinois State University
Human Resources
Campus Box 1300
Normal IL 61790-1300

The Civil Service examination for this classification is based on your application materials and responses to the supplemental questions. No participation other than submission of applicant materials is required from applicants that qualify to take the exam. If you meet the minimum required qualifications for this position you will receive a score calculated based on your education and experience and your name will be placed on the active employment register by exam score. After the application deadline the names within the top three scores will be referred to the department for interview.

Illinois State University is authorized to do business within the State of Illinois. All work under this appointment is required to be performed from within the State of Illinois.

Applicants for this position must be authorized to work in the U.S. without ISU sponsorship. Sponsorship for work authorization will not be considered for this position.

Contact Information for Applicants

Mackenzie Chapman
Human Resources

Important Information for Applicants

This position is subject to a criminal background investigation and if applicable an employment history review based on University Policy 3.1.30 and any offer of employment is contingent upon you passing a satisfactory criminal background investigation and/or an employment history review. You may not begin work until the criminal background investigation results have been received and cleared by Human Resources.

Illinois State University is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability or status as a protected veteran.

If you are an individual with a disability and need a reasonable accommodation under the Americans with Disabilities Act (ADA) or other state or federal law you may request an accommodation by contacting the Office of Equal Opportunity and Access at . The Office of Equal Opportunity and Access will hold any confidential information you provide in confidence.

If you are having difficulty accessing the system please call Human Resources at .