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About the Role

Health Admins is seeking a Claims Processor to manage the medical claims environment, optimize performance, and drive continuous improvements. The ideal candidate will be meticulous, customer-focused, and possess strong research acumen, attention to detail, and customer service skills.

Responsibilities

• Review and process medical claims submitted by members or providers promptly and accurately.
• Verify the accuracy and completeness of claim information, including patient demographics, diagnoses, procedures, and billing codes.
• Ensure compliance with insurance policies and industry standards.
• Investigate and resolve any discrepancies or issues related to claim submissions.
• Conduct comprehensive medical claims audits to identify errors, discrepancies, or fraudulent activities.
• Analyze claim documentation, including medical records and billing statements, to ensure adherence to coding guidelines and reimbursement policies.
• Research complex medical billing and coding issues to support claims processing and audit activities.
• Interpret coding guidelines, reimbursement policies, and legal requirements to determine appropriate claim adjudication.
• Provide recommendations for improving claims submission procedures and enhancing reimbursement accuracy.
• Serve as members' primary point of contact regarding claims inquiries and resolution.
• Respond promptly to customer inquiries and concerns with professionalism and empathy.
• Collaborate with cross-functional teams to address customer issues and ensure timely resolution.

Requirements

• Proven experience in medical claims processing and healthcare reimbursement.

Skills

• Strong knowledge of medical terminology, medical coding, and insurance billing practices.
• Excellent analytical skills with the ability to interpret complex healthcare regulations and guidelines.
• Exceptional attention to detail and accuracy in data entry and documentation.
• Effective verbal and written communication skills with a customer-centric approach.
• Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.
• Excellent verbal, written and interpersonal communication skills.
• Must be a self-motivator and self-starter.
• Exceptional listening and analytical skills.
• Solid time management skills.
• Ability to multitask and successfully operate in a fast paced, team environment.
• Must adapt well to change and successfully set and adjust priorities as needed.
• SalesForce Experience
• Google Suite Experience
• Claims Management Software experience

Location

• Remote (Texas preferred)

Work Type

• Full-time
• Remote

Education Level

• High School Diploma or equivalent

Benefits

• Competitive salary and benefits package
• Dynamic and innovative work environment
• Opportunities for professional growth and development

About the Company

• Health Admins is a leading force in healthcare administration, on a journey to become a premier technology-driven healthcare platform.
• Our vision is anchored in a commitment to Getting Better Every Step of the Way.
• We are dedicated to providing innovative, efficient solutions that elevate the healthcare experience for the members and clients we serve.

Equal Opportunity

• We are deeply committed to building a workplace and global community where inclusion is not only valued but prioritized.
• We are proud to be an equal opportunity employer, seeking to create a welcoming and diverse environment.
• All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, family status, marital status, sexual orientation, national origin, genetics, neuro diversity, disability, age or veteran status, or any other non-merit based or legally protected grounds.
• We are committed to providing reasonable accommodation to qualified individuals with disabilities in the employment application process.