Claims Processor l

Primary Duties:

• Receive, analyze and process assigned claims by product (medical, dental, vision, FSA or HRA) and group.  Ensure accurate processing based on benefit plan design and/or regulations.


• Evaluate underpayments, resolve non-payments and rejected claims.  Follow through until the claim is completely resolved and check is issued.


• Create appropriate Explanation of Benefits or letter to provider for each claim.


• Identify and escalate claims for review or audit based on business rules.


• Ensure required documentation or reporting is completed timely and accurately.


• Answer incoming telephone calls related to claim processing, provider support and member benefit coverage options.


• Make outgoing calls to members and providers to obtain additional information as needed.


• Retrieve and sort mail, fax and email to ensure timely and accurate handling and response.


• Perform clerical functions including data entry, filing, and sorting, typing, organizing, and recording information.


• Train co-workers and new employees, as required.


• Perform various related duties as assigned.

Position Requirements:

• High school diploma or equivalent required, post high school education preferred.


• Minimum two years of experience as a medical claims processor, medical biller or a similar service position in the health care industry.


• Must be flexible with scheduled work hours.


• Must have strong customer service orientation and excellent communication skills, and the ability to work effectively with clients, medical providers and plan members.    


• Proficient PC skills in Windows-based applications.


• Ability to be flexible and quickly adapt to the changing needs in the department.


• Must be highly organized with strong attention to detail.


• Must be dependable and demonstrate responsible work patterns.


• Must have a high level of professionalism and courtesy.

PHYSICAL DEMANDS

This position requires sitting, standing and occasional light to medium lifting.

The Perks of Joining Our Team:

We believe in taking care of our team.  You'll enjoy a comprehensive benefits package designed to support your well-being and financial future:

• Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.


• Time to Recharge: Paid vacation and holiday pay.


• Focus on Your Wellness: We offer a robust Employee Wellness Program.


• Invest in Your Future: 401 k with a company match.


• Support System: Employee Assistance Program provides confidential support and counseling.


• Get Rewarded for Referring Great People:  Employee referral program.

ProCare Rx will never ask for a financial commitment from an applicant, as part of our recruitment process.  All interviews are conducted in-person OR through video conference invitations from official company emails.  For inquiries, please contact our official recruitment team at [email protected].

ProCare Rx is an Equal Opportunity Employer.