Inventory Claim Processor

Claims Examiner

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard "Point A to Point B." We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. Point C is looking for a detail-oriented and motivated Claims Examiner to join our team. In this role, you'll be responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations. Adjudicate new claims and process adjustments, including denials upon receipt of additional information

Manage individual inventory to ensure timely turnaround and production goals are met

Ensure claims are processed in accordance with stop loss contract terms

Follow up on missing or incomplete information to ensure claims can be accurately processed

Maintain minimum production, financial, and procedural accuracy standards on a monthly basis

Experience with Third Party Administrator (TPA) or self-funded claims administration preferred

At least 2+ years of experience in insurance claims processing required

Experience reviewing and finalizing claim payments for accuracy in accordance with plan policies

Ability to interpret and apply plan documents to ensure accurate claims adjudication

Demonstrated understanding of both claim review processes and underlying benefit plan design

Experience with HealthPac, El Dorado, Javelina, or VBA systems preferred

Working knowledge of CPT and ICD-10 coding

Basic understanding of medical terminology

Strong communication and customer service skills

Proficiency in Microsoft Office and general computer applications

Ability to maintain confidentiality and comply with all company policies and procedures

Able to work independently with minimal supervision

Ability to prioritize, multitask, and work overtime as needed

Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Comprehensive medical, dental, vision, and life insurance coverage

• 401(k) retirement plan with employer match
• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
• Paid time off (PTO) and disability leave
• Employee Assistance Program (EAP)

Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.