Job Description

Medical Associates Health Plans is looking for a Claims Processor to join our team!

The Position:

On a daily basis, this person will utilize their professional oral and written communication skills along with their ability to collaborate successfully with a team. Additionally, a successful person in this role will be organized and efficient at multi-tasking, may have some prior claims processing experience, and be proficient at Microsoft Excel and typing.

Benefits Package Includes:

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing)
• Flexible Paid Time Off Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

What you'll be doing:

• Examine, process, calculate, and pay claims after verification of fee schedules and contract benefits in compliance with state laws, employer contracts, policies and procedures, and production standards established by the company.
• Assist Health Care Services and Subrogation Specialist to ensure timely resolution of claims pended for subrogation and medical authorization.
• Possess knowledge of all health plan benefit plans and provide interpretation to all constituents including potential members, brokers, members, providers, employers, and staff.
• Make appropriate adjustments to previously adjudicated claims.

Knowledge, Skills and Abilities:

Education - High school diploma or GED required.

Experience - One to three years of similar or related experience.

Other Skills - Familiar with Microsoft Office applications, particularly Word and Excel.