You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

The Claims Processor is responsible for reviewing and processing healthcare claims, including medical, dental, and vision, to ensure accuracy, completeness, and compliance with applicable plan provisions and organizational guidelines. This role involves evaluating claim information, determining eligibility and benefit coverage, maintaining processing quality standards, and meeting established productivity goals in a fast-paced environment.

Key Responsibilities

• Review and process healthcare claims for accuracy, completeness, and eligibility.
• Enter and update claim information within claims processing systems.
• Analyze claim documentation and apply benefit provisions according to plan guidelines and established procedures.
• Verify that all required information is complete and identify discrepancies or missing documentation as needed.
• Maintain assigned claim inventory and prioritize workload to meet turnaround expectations and service standards.
• Ensure compliance with applicable policies, procedures, and regulatory requirements.
• Track daily work activity and complete required productivity or operational reporting.
• Consistently meet quality, accuracy, productivity, and attendance expectations.
• Adapt to changing priorities, workflow demands, and process improvements.
• Demonstrate professionalism, sound judgment, and attention to detail while working under deadlines.
• Support team objectives by assisting with special projects, cross-functional initiatives, and other duties as assigned.
• Be available to work additional hours, including overtime, when business needs require.

Qualifications

• 2-5 years claims processing in self-funded claims
• Expansive knowledge of medical terminology.
• Computer skills in MS Word, Excel, PowerPoint, & Outlook at the intermediate or higher level.
• Associates degree preferred
• WLT MediClaims experience preferred

Skills

• Proficiency in MS Word, Excel, PowerPoint, & Outlook
• Strong communication and teamwork skills

Additional Requirements

• Remote position
• Be available to work M-F, 9:00 am - 5:00 pm (East Coast Hours)

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 is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

^*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