You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a dedicated Claims Processor responsible for processing medical claims with precision and consistency. The role involves ensuring claims are assessed according to established benefit and eligibility guidelines and maintaining high production and quality standards.
Key Responsibilities
- Review and process medical claims accurately and thoroughly according to benefits and eligibility guidelines.
- Pay, pend, or deny claims based on established processing criteria.
- Request additional information as needed using the ACE Form Letters system.
- Refer claims to supervisors for review of COB and OIC information.
- Utilize Administrative Guidelines as a resource during processing.
- Manage the CSC Referral Inbox daily to address claims issues promptly.
- Track and report production hours weekly.
- Update other insurance and annual enrollment information as required (COB.
- Keep processing skill sets current by reviewing updated Administrative Guidelines weekly.
- Occasionally required to share knowledge or tasks specific to your role.
- Perform other duties as assigned.
Qualifications
- Minimum of 1 year of dedicated medical claim processing experience from major insurance networks.
- Understanding of CPT codes, diagnosis codes, COB adjustments, HIPAA, and medical record interpretation.
- Proficient computer skills and intermediate Excel capabilities.
- Ability to interpret and retain detailed information from Summary Plan Descriptions for multiple plans.
- Knowledge of benefits and eligibility based on Trust rules.
Experience
- Minimum of 1 year in medical claim processing from major insurance networks.
Skills
- Technical skills: Proficient in Microsoft Excel and database management.
- Soft skills: Detail-oriented, thorough, and analytical thinking.
Additional Requirements
N/A
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
Required Employment / Compliance Language
Medix complies with applicable employment regulations and practices.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients
