(717) 757-4800 labor@sesametemps.com

Medical Claims Analyst

Responsibilities: Performs a variety of duties related to the processing and paying of medical insurance claims. Communicates with claimants, providers and third-party payors to answer questions and resolve problems. Enters/retrieves a variety of claims related data into/from computer, maintaining confidentiality. Pays, denies and/or excludes claims according to the plan document. Duties and Responsibilities: Sorts claims by category and enters appropriate information into computer. Adjudicates claims and makes payments, denials and/or exclusions according to the plan document. Reviews claim information for accuracy, completeness and consistency. Applies the appropriate coordination of benefits rules, investigates pre-existing conditions and subrogation, and determines appropriate level of benefits based on medical emergency criteria. Investigates processed claims in response to inquiries, questions and complaints from providers, claimants and third-party payors. Maintains established policies and procedures, objectives, quality assessment and safety standards. Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation. The following are nonessential job accountabilities for ADA purposes: Maintains appropriate records, reports, and files as required. Attends meetings as required. Performs other related duties as identified. Compensation: Position is $15/hour, possibly higher depending upon skill set, experience and interview. Position is lasting for six months, possibly longer. Qualifications: Minimum Education High School or G.E.D. Minimum Experience 6 – 12 months. Must have prior experience in filling our 1500 Forms and UB Forms. Pref Course(s)/Training Medical Terminology. Will be required to pass a nicotine (tobacco test), drug test, and additional testing. Due to working for a medical facility, vaccinations will be required. Submit your resume here