Claims Processor

Southfield, MI - USA

Monthly Salary: Not Disclosed

Posted on: 03-11-2025

Vacancies: 1 Vacancy

Department:

Client Services

Job Summary

Primary Duties:
ï Receive analyze and process assigned claims by product (medical dental vision FSA or HRA) and
group. Ensure accurate processing based on benefit plan design and/or regulations.
ï Evaluate underpayments resolve non-payments and rejected claims. Follow through until the
claim is completely resolved and check is issued.
ï Create appropriate Explanation of Benefits or letter to provider for each claim.
ï Identify and escalate claims for review or audit based on business rules.
ï Ensure required documentation or reporting is completed timely and accurately.
ï Answer incoming telephone calls related to claim processing provider support and member benefit
coverage options.
ï Make outgoing calls to members and providers to obtain additional information as needed.
ï Retrieve and sort mail fax and email to ensure timely and accurate handling and response.
ï Perform clerical functions including data entry filing and sorting typing organizing and recording
information.
ï Train co-workers and new employees as required.
ï Perform various related duties as assigned.
Position Requirements:
ï High school diploma or equivalent required post high school education preferred.
ï Minimum two years of experience as a medical claims processor medical biller or a similar service
position in the health care industry.
ï Must be flexible with scheduled work hours.
ï Must have strong customer service orientation and excellent communication skills and the ability
to work effectively with clients medical providers and plan members.
ï Proficient PC skills in Windows-based applications.
ï Ability to be flexible and quickly adapt to the changing needs in the department.
ï Must be highly organized with strong attention to detail.
ï Must be dependable and demonstrate responsible work patterns.
ï Must have a high level of professionalism and courtesy.