A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
Medical Claims Processor Mid-America Carpenters Benefits Chicago, IL Job Details Full-time $22 - $24 an hour 7 hours ago Benefits Health savings account Health insurance Dental insurance Tuition reimbursement Paid time off Parental leave Vision insurance Life insurance Retirement plan Prescription drug insurance Qualifications Bilingual Spanish Confidential information handling Multitasking Medical coding guidelines Attention to detail Document review Organizational skills Medical terminology Documentation review Full Job Description Please take a moment to review our benefits package online, which includes, but is not limited to: 100% employer-funded pension and SRP 100% employer-paid medical, dental, and vision coverage 100% employer-paid HRA, funded at $1.50 per hour worked The only deductions from your paycheck are taxes!
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//carpenterbenefits.org/isite135/eremit.dll/13501/home Job Responsibilities Interpret and apply Plan rules, provisions, and regulatory requirements when adjudicating claims. Communicate Plan policies and regulations clearly, accurately, and professionally to internal and external participants. Adjudicate claims using appropriate diagnostic and procedural codes in accordance with Plan guidelines. Maintain up-to-date knowledge of Plan changes, protocol updates, and process improvements. Perform claim adjudication support activities, including requesting additional documentation from participants, providers, and other insurance carriers. Accurately document patient comments and claim notes within the system. Verify the accuracy of incoming claim data and update system records as required. Identify claims requiring referral for adjustments, corrections, or subrogation and document the appropriate action taken. Apply coordination of benefits (COB) provisions and adjudicate claims accordingly. Support team operations by assisting colleagues and participating in cross-training initiatives as needed. Review and respond to claim reopen requests from the Participant Services team. Consistently meet or exceed established quality and productivity standards. Perform additional duties as assigned. Basic Qualifications Previous experience in claims processing is required. Dependable attendance and punctuality. Working knowledge of medical terminology, diagnostic coding, CPT, and HCPCS coding systems. Ability to read, interpret, and evaluate medical records and related documentation. Strong organizational skills with a high level of attention to detail. Ability to manage multiple tasks, prioritize workload, and complete assignments accurately within established timelines under moderate supervision. Demonstrated ability to make decisions in accordance with established policies, procedures, and guidelines. Strong problem-solving and analytical skills. Excellent written and verbal communication skills. Ability to handle confidential and sensitive information with discretion and professionalism. Ability to work collaboratively and contribute positively in a team-based environment. Work Authorization No calls or agencies please. The Mid-America Carpenters Regional Benefit Services will only employ those who are legally authorized to work in the United States. This is not a position for which sponsorship will be provided. Individuals with temporary visas such as E, F-1, H-1, H-2, L, B, J, or TN or who need sponsorship for work authorization now or in the future, are not eligible for hire. Equal Opportunity Employer The Mid-America Carpenters Regional Benefit Services is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, race, color, religion, national origin, age, marital status, political affiliation, sexual orientation, gender identity, genetic information, disability, or protected veteran status. We are committed to providing a workplace free of any discrimination or harassment.
Pay:
$22.00 - $24.00 per hour Expected hours: 40.0 per week
Benefits:
Dental insurance Health insurance Health savings account Life insurance Paid time off Parental leave Prescription drug insurance Retirement plan Tuition reimbursement Vision insurance
