Medical Claims Processor

Job Description

Job Description

Join the DATAMARK, Inc. Team as a Medical Claims Processor!

Are you looking for an exciting opportunity where your attention to detail and problem-solving skills make a real impact? Do you thrive in an environment that requires critical thinking and strong judgment? If so, we have the perfect role for you! As a Medical Claims Processor at DATAMARK, you'll play a vital role in the success of our operations by ensuring accurate and efficient back-office support.

We are seeking a detail-oriented and performance-driven Medical Claims Processor to support patients prescribed complex and high-cost drug therapies. In this role, you will be responsible for verifying insurance coverage, conducting research, and resolving coverage-related issues to ensure timely and accurate prescription processing.

This is a back-office position that requires strong analytical skills, efficiency, and comfort with outbound calls to insurance providers and patients.

• Verify insurance coverage for new and existing patients to support timely prescription fulfillment
• Pull and review customer accounts to assess eligibility, benefits, and coverage limitations
• Conduct detailed research across multiple systems and portals
• Initiate and complete outbound calls (OB calls) to insurance companies, pharmacies, and other partners to resolve coverage issues
• Accurately document findings, decisions, and next steps in internal systems
• Meet or exceed productivity expectations while maintaining accuracy
• Identify and escalate complex cases or discrepancies as appropriate
• Support patients requiring specialty, high-cost, or complex therapies through thorough and timely insurance determination

Requirements

• Previous experience in insurance verification, benefits investigation, pharmacy operations, or healthcare administration preferred
• Knowledge of medical insurance terminology (deductibles, copays, prior authorizations, etc.)
• Strong attention to detail and ability to process high volumes of information accurately
• Excellent reading comprehension and research abilities
• Comfortable making outbound calls to resolve insurance or coverage-related issues
• Strong problem-solving and critical-thinking skills
• Ability to manage productivity metrics in a fast-paced environment
• Basic computer proficiency and experience navigating multiple systems

Benefits

• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (401k, IRA)
• Life Insurance (Basic, Voluntary & AD&D)
• Paid Time Off
• Short Term & Long Term Disability
• Training & Development
• Wellness Resources
• $16.50 per hour