Medical Claims Analyst (full-time / remote / hybrid)

Prairie States Enterprises - Sheboygan, WI

Full-time - Entry Level

Remote - Sheboygan, WI

Insurance Carriers and Related Activities

About the position

The Medical Claims Analyst position is a full-time role with a hybrid remote work arrangement based in Sheboygan, WI. The primary focus of this role is to adjudicate and process medical, dental, and vision claims while interpreting relevant coding and medical terminology. The ideal candidate will possess strong customer service skills and will be responsible for ensuring accurate and timely claims processing in accordance with established standards.

Responsibilities

• Review, research, investigate, adjudicate, and process claims for assigned relationships.
• Provide high-level customer service when interacting with members, Human Resource contacts, employees, providers, and internal staff.
• Read and comprehend instructions and draft short correspondence and memos.
• Effectively present information in one-on-one and small group situations to customers, clients, and other employees.
• Understand all aspects of plan documents for assigned groups and groups within their assigned pod.
• Demonstrate understanding of electronic claims from exceptions to pass-through audits.
• Identify potential large claims and understand the stop-loss process and pend claims appropriately.
• Perform daily duties and process claims with minimal direction, asking questions appropriately.
• Ensure accurate and timely entry of claims data with a high level of quality according to department policies and procedures.
• Meet established productivity and quality standards for claims processing.
• Assist in answering overflow of outside phone calls and direct calls appropriately.
• Complete other Claims Department duties and special projects as assigned.

Requirements

• High School Diploma or GED required.
• Post-secondary education in the medical field and medical terminology is highly preferred.
• 1 to 3 years of experience in an insurance or medical office setting is required.
• Strong customer service and communication skills are required.

Benefits

• Competitive compensation based on experience.
• Comprehensive benefit package including Medical, Dental, Vision, Life, STD/LTD, FSA.
• Paid Time Off and personal days.
• 401k with match.
• Wellness and exercise membership.
• Opportunities for meaningful career growth.