Hybrid Medical Claims Examiner at Managed Care Staffers

Hybrid Temp to Hire F/T Medical Claims Examiners Needed in Chicago Near Chinatown

Our client a busy and growing Non-For-Profit Union Health & Welfare Fund located in Chicago near Chinatown has immediate staffing needs for some experienced hybrid temporary to hire full-time Medical Claims Examiners. You will be responsible for processing 100+ medical claims per day for payment utilizing the Basys Software with a 98% accuracy rate. 

You must be available to start group training on Monday, January 6, 2024: possible onsite training the office in Chicago for several days Monday-Friday (9:00am to 5:00pm).  Although after picking up the computer at the client’s office on the first day, training may be remote.  While identified as a hybrid position these positions will largely be a remote position after the first several days.  The position allows flexible hours between the hours of Monday-Friday (8:00am to 5:00pm) for a total of 37.5 hours paid hours per week.

We understand that you cannot submit any comments or text with your resume. If you apply through Monster, please send a separate email to emurawski[at]managedcarestaffers.com with the answers to the following questions in order to be considered for this position:

1. How many years of medical claims processing experience do you currently have? 
2. Do you have any Basys Software experience? If yes, how many years?
3. What is your expected minimum hourly compensation working 37.5 hrs. per week?
4. Is Chicago near Chinatown a commutable location for you for training and computer pickup?
5. Are you available to start onsite training on Monday, January 6, 2025?

Job Responsibilities

• You will be required to process 100+ both PPO and HMO medical claims per day with a 98% accuracy rate and to ensure that all of the necessary claim information is present.
• Review provider reconsiderations and reprocess the claim or generate letter(s) in response to the request.
• Process check-run cycles and check-run audits when assigned.
• Perform audits of auto-adjudicated claims when assigned.
• Identify and report system issues, test and troubleshoot system configuration, completing reports, and run other system tasks or reports as assigned.
• Monitor pending claims to ensure that unnecessary delays are avoided.
• Correspond to providers, members and external vendors via mail, email or phone
• Attend and participate in various meetings, including monthly all staff meetings, department meetings, training sessions, etc.
• Create one-on-one (1:1) agendas with the Director of Health Plans & Medical Claims using the Purpose, Outcome and Process (POP) Model and keeping thorough notes for each meeting

Job Requirements

• A High School Diploma is required a college degree is preferred.
• At least 5 years of recent medical PPO and HMO claims processing experience.
• Knowledge and understanding of the healthcare industry, including basic medical claim processing, subrogation, ICD-10 Diagnosis Codes, CPT Procedures Coding, HCPC Codes, HCFA 1500, and UB-02 claim forms
• Strong understanding of plan documents and insurance policies
• Intermediate Microsoft Office Proficiency in (Word, Excel, and Outlook) and the ability to type at least 40 WPM.

If you or anyone you know is interested, qualified, and currently available for employment please send an updated resume to us for immediate review and consideration.