Sr. Medical Claims Examiner Representative

Senior Medical Claims Examiner/Representative

For more than 70 years, the Motion Picture Industry Pension & Health Plans (MPI) has proudly served the entertainment community by supporting the financial and healthcare well-being of the people who bring stories to life from set crews to post-production pros.

We're not just analysts and benefit specialists; we're problem-solvers, collaborators, and stewards of trust. Our teams are guided by a simple mission: to improve the lives of those who work in the entertainment industry through accuracy, accountability, and care.

MPI is recognized as a five-time certified Great Place to Work employer and recipient of the World at Work Seal of Distinction because we believe people do their best work when they're respected, supported, and inspired.

Role Overview:

MPI is seeking a Senior Medical Claims Examiner/Representative. The Examiner/Representative reviews and processes escalated health claims for reconsideration, confirms accumulator benefits to outside vendors, and communicates (by phone, email, and written correspondence) with participants and providers' offices about claims and benefit issues.

Qualified candidates, please submit your current resume with a cover letter for consideration. Submissions will be reviewed; only candidates most closely matching the requirements of the position will be contacted. MPI requires employees to be vaccinated against Covid-19 with exceptions as required by law.

What You Will Need:

• High school Diploma or GED required. Some college preferred.
• 2+ years of verifiable claims processing experience with quality average of 95%.
• 1+ years of customer service/call handling experience in a healthcare environment.
• Knowledge of: CPT, HCPCs, ICD-9, COB, and Medical Terminology.
• Intermediate level of proficiency in PC skills including MS Word, Outlook, and Excel
• Familiarity with QNXT configuration.
• Clear and effective oral and written communication skills.
• Excellent attendance & reliability with the ability to work overtime/extended hours as needed.
• Strong organizational skills and attention to detail
• Ability to handle fast-paced work while meeting production and quality assurance goals/standards
• Good interpersonal skills; able to interact with individuals at all levels.
• Ability to accept direction and developmental guidance from lead and manager.
• Flexible team player, with a positive, cooperative, and helpful attitude; willing to assume additional duties as needed.

Preferred Qualifications:

• Knowledge of MPI Plan benefits.
• Working knowledge of Anthem WGS Claims system.
• In-depth knowledge of V3 Eligibility system.

What You Will Do:

• Review and process requests for claim adjustments including responses to providers and participants.
• Process a high volume of complex or technically difficult claims.
• Perform investigation / research as needed for the processing of medical claims.
• Make outbound calls to MPI participants and/or providers regarding the status of a claim.
• Contact providers regarding misrouted or unidentified claims.
• Contact providers requesting additional information (medical records, consultation notes, progress notes and prescriptions).
• Actively execute appropriate claim activities to ensure consistent quality/configuration of claims processing.
• Document issues and actions effectively and efficiently utilize internal systems.
• Test configuration changes.
• Participate in development and maintenance of departmental procedures.
• Provide accumulator benefits to MPI external medical partners.
• Complete other duties as assigned including, but not limited to, assisting other departments and units as needed.

Compensation & Benefits:

This is a Union-Affiliated position.

MPI offers a comprehensive benefits package, including free medical, dental, and vision coverage, generous paid time off, retirement benefits, and professional development opportunities.

Motion Picture Industry Pension & Health Plans (MPI) is an equal opportunity employer and does not discriminate against any applicant or employee on the basis of race, religion, color, national origin, ancestry, sex, sexual orientation, gender identity, age over 40, marital status, veteran status, mental or physical disability, pregnancy, genetic information, or any other basis prohibited by law. Any applicant who, because of disability, requires accommodation or assistance in completing this application or at any time during the application process should contact the Human Resources Department. MPI also provides reasonable accommodations to disabled employees consistent with its obligations under applicable law.