Medical Claims Processor

Are you a detail-oriented professional with a knack for numbers and a passion for excellent customer service? FCE Benefits Administrators, Inc is looking for a Claims Processor to join our team! In this role, you will play a vital part in ensuring the accurate, timely review and processing of health and ancillary benefit claims in compliance with company policies and regulations. If you thrive in a fast-paced environment and love problem-solving, we want to hear from you! *Experience processing claims for self-funded benefit plans is strongly preferred. What You’ll Do (Key Responsibilities): Review & Verify: Meticulously evaluate incoming medical, dental, Vision & insurance, HRA, Critical Illness, and Accident claims for accuracy, completeness, and adherence to policy provisions. Review claim information for completeness and accuracy, including eligibility, benefits, coding, pricing, prior authorization requirements, coordination of benefits, and supporting documentation, as applicable. Research: Research and resolve claim discrepancies, edits, denials, and other processing issues. Data Entry: Enter and update claims data accurately into our claims management software. Communicate: Interact effectively with clients, insurance agents, healthcare providers, account executives, and internal teams to resolve discrepancies or obtain missing information. Calculate Payments: Review and process payments for approved routine claims. Quality & Compliance: Maintain organized, confidential records while strictly adhering to regulatory requirements like HIPAA. Conduct claim audits and quality reviews to support accurate and consistent claim processing. Meet established accuracy, productivity, and turnaround-time expectations. Participate in training, special projects, process improvements, and other departmental initiatives as assigned. What We’re Looking For (Qualifications & Skills): Education: High school diploma or equivalent required (Associate's degree or training in medical billing/coding is a plus!) Experience: 2 years of experience in medical claims processing, data entry, customer service, or general office administration. Technical Skills: Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and strong 10-key data entry skills. Familiarity with EHR systems or claims software is a major advantage. Working knowledge of health insurance terminology, claim forms, benefit structures, and claim-processing procedure. Soft Skills: Exceptional attention to detail, strong written/verbal communication, and a high level of integrity when handling confidential information. Ability to manage priorities, meet deadlines, and work effectively both independently and as a team member. Preferred Qualifications and Skills: Experience with self-funded health and welfare benefit plans. Experience working for a third-party administrator or in a similar claims-administration environment. Experience with claim adjustments, audits, payment corrections, and escalated claim research. Standard office environment. Involves prolonged periods of sitting and computer use. Ability to occasionally lift up to 20 lbs (for physical records/mail). BENEFITS OFFERED: We recognize that talented people are attracted to companies that provide competitive pay, comprehensive benefit packages, and outstanding advancement opportunities. For this reason, we offer a comprehensive benefits plan including the following: Competitive overall compensation package Career enhancement and growth opportunities 401(k) Medical, dental, and vision coverage Life/AD&D insurance Accident/critical illness insurance FSA and HSA accounts Competitive paid time off Continuing education and career certification Service recognition compensation Work/life resources FCE is an equal opportunity employer and is committed to creating an inclusive and diverse workplace. #J-18808-Ljbffr