Claims Processor

Job Description

Job Description

Job Description:

Our client is seeking a Claims Processor to support a long‐standing benefits organization. This role supports U.S. Benefits, a small, experienced claims processing team within a multi‐employer trust environment. This position is open due to upcoming retirements of senior claims processors and will play a key role in claims processing, auditing, adjudication logic, and knowledge transfer. The ideal candidate has strong medical and/or dental claims experience and is comfortable working in a lower‐volume, high‐accuracy environment.

Responsibilities:

Process medical and/or dental claims across the full lifecycle:

• Intake and review
• Data entry and validation
• Claims adjudication
• Follow‐ups and issue resolution
• Appeals processing
• Final claims resolution
• Audit claims processed by other team members
• Apply adjudication logic and benefit plan rules accurately
• Support claims system configuration and processing logic
• Assist with reporting, data needs, and coding requirements
• Respond to member and provider inquiries via phone and email (moderate volume)
• Collaborate with internal teams to ensure compliance and accuracy
• Maintain detailed documentation and adhere to regulatory requirements

Claims Volume:

• A few thousand claims per month that is shared across a 3–4 person team
• Emphasis on quality and accuracy over high volume

Must‐Have Qualifications:

• 2+ years of medical and/or dental claims processing experience
• 1+ Years of experience with claims adjudication logic and appeals
• 1+ years of experience auditing claims and ensuring compliance
• Familiarity with claims processing systems and configuration tools
• Experience handling customer inquiries via phone and email
• High attention to detail and ability to work independently
• Comfortable working in a small team environment

Nice‐to‐Have / Pluses:

• Experience with reporting and data analysis related to claims
• Coding or system configuration experience
• Background in multi‐employer trusts or benefits administration
• Experience supporting process improvement initiatives

Work Schedule:

• Monday–Friday
• Hours: 8:00 AM – 5:00 PM
• 40 hours/week

Additional Notes:

• Small office environment
• Pet friendly office
• Reporting directly to the President
• Strong knowledge of Medical or Dental Claims
• Great work environment
• Not a production‐heavy claims environment; accuracy is key