Medical Claims Processor

Position Overview Our client, a growing Third-Party Administrator (TPA) specializing in Health & Welfare benefits administration, is seeking a detail-oriented Medical Claims Processor to join their team. This administrative role is responsible for reviewing, processing, and adjudicating medical claims in accordance with plan provisions, eligibility requirements, and client-specific guidelines. The ideal candidate will have strong organizational skills, a high level of accuracy, and experience within medical claims, benefits administration, or the insurance industry. Key Responsibilities Review and process medical, dental, vision, and other Health & Welfare claims accurately and timely. Verify participant eligibility, coverage, and claim details based on plan provisions. Ensure claims are adjudicated in accordance with client plans, policies, and established procedures. Research and resolve claim discrepancies, missing information, and processing issues. Communicate with providers, participants, and internal departments regarding claim status and benefit questions. Maintain accurate claim records and supporting documentation within the administration system. Assist with quality control reviews, audits, and compliance-related activities. Escalate complex claims or unusual situations to management as needed. Support ongoing process improvement initiatives and departmental goals. Maintain confidentiality and compliance with HIPAA and other applicable regulations. Qualifications High school diploma or equivalent required; Associate's or Bachelor's degree preferred. 1-3+ years of experience in medical claims processing, benefits administration, insurance, or a related field. Understanding of Health & Welfare benefit plans and medical claims administration. Familiarity with medical terminology, eligibility verification, EOBs, and claims workflows preferred. Strong attention to detail and commitment to accuracy. Excellent organizational and time management skills. Proficiency in Microsoft Office, including Outlook and Excel. Ability to manage multiple priorities in a fast-paced environment. Strong verbal and written communication skills. Preferred Experience Experience working for a TPA, insurance carrier, health plan, or employee benefits organization. Exposure to self-funded employer health plans. Experience with claims administration platforms and benefits management systems.