Medical Claims Specialist

Madison, Wisconsin
Insurance (Management Occupations)
Job Type
Temp to Perm
Working Hours
8:00 AM - 5:00 PM
US$ 16.00 per hour
Ref. Number
Claudine Baccheschi, Spherion
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Job Description

Join our fabulous health insurance and clinics client as they hire their next Medical Claims Processor! This position is temp-to-hire offers an excellent working environment with opportunities for advancement!

The Medical Claims Specialist reviews high level, complex claims for accuracy, completion, and to obtain missing information as necessary. Determines claims coverage by examining company records.

1.-Process claims in accordance with the claims processing system and other department guidelines.

2.-Research problem claims accounts; reverse and reprocess claims as necessary.

3.-Determine liability as it relates to COB claims.

4.-Identify large dollar claims, following standard department process.

5.-Review provider status to determine participating/nonparticipating, primary, referral and correct reimbursement level, which may include re-pricing.

6.-Process written inquiries from providers and subscribers regarding benefits and claims and escalate, as appropriate.

Working hours: 8:00 AM - 5:00 PM

-Must have medical claims processing experience; ideally 3-4 years
-Possess excellent ability to use Word, Excel, and be able to type 40 wpm
-A positive attitude and willingness to problem solve for tough claim cases

High School

1-4 years

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Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law.

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