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Medical Claims Processor and Benefits Specialist

Painters District Council #30 Benefits Office

in Aurora IL

Self-administered employee benefits office affiliated with Painters District Council #30, a progressive construction labor union representing employees in the painting, drywall finishing and glazing trades, seeks experienced medical claims processor, with a desire to expand their knowledge and individual capacity through supported professional development, for full time employment in Aurora, Il.

The ideal candidate is a person who is detail oriented and technologically capable and who has significant experience processing medical claims in a multi-employer environment, experience interacting with plan participants and medical providers, a working knowledge of multi-employer benefit fund administrative structures and regulatory standards, the desire to improve understanding and utilization of benefits among plan participants, and an eagerness to work in a respectful, collaborative and supportive environment that values the thoughtful consideration and management of industry challenges and emerging areas of focus.

Primary Responsibilities:

  • Accurate and productive processing of medical, HRA, and weekly disability benefit claims in accordance with applicable plan documents
  • Effective communication, both verbal and written, with plan participants, medical providers, and fund vendors regarding claims discrepancies, claims payment status, case management, and independent medical review requests
  • General plan participant servicing, i.e. managing phone and walk-in inquiries, guiding plan participants to appropriate organizational resources, and plan participant support in benefits utilization
  • Assist fund management in the completion of special projects including research, writing assistance, proofreading/editing, and discussion of complex problems with implications for the benefits plans
  • Data entry, scanning, filing, mailings, and other clerical tasks

Minimum Qualifications:


  • High School Diploma or GED


  • Three (3) years of  full time employment experience as a medical claims processor

Knowledge and Skills:

  • Ability to understand and apply health plan provisions to submitted medical claims
  • Knowledge of medical terminology, CPT codes, ICD-9 / ICD-10, Medicare/Medicaid, and HIPAA standards
  • Ability to effectively communicate to stakeholders concepts common to multi-employer employee health benefits such as eligibility, PPO network structure, annual deductibles, coinsurance, copays, coordination of benefits, explanation of benefit statements, and IRS Publication 502: Medical and Dental Expenses
  • Ability to deliver excellent service to plan participants through responsiveness, professionalism, follow-through, and respect for language and cultural diversity
  • Ability to work in a team-oriented environment while maintaining focus on individual performance and development goals
  • Ability to identify and resolve issues using both internal and external resources
  • Excellent organization skills with strong attention to detail and the ability to manage multiple priorities and deadlines
  • Proficiency in MS Word, MS Outlook, and the creation, filing, and dissemination of electronic documents and records

Preferred Enhanced Qualifications:


  • Associates or Bachelors degree in human resources, public administration, social work, health science, communication, or other relevant discipline
  • Third-party certification in medical terminology
  • Third-party (IFEBP, or other) certification in employee benefit plan administration


  • Five (5) or more years of full time employment experience as a medical claims processor in multi-employer benefits administration

Knowledge and Skills:

  • Bilingual fluency (speaking and writing) English and Spanish
  • Experience in claims adjudication on an ISSI data management platform
  • Experience in the identification of employee benefits fraud and patterns of abuse
  • Experience identifying, compiling, analyzing and presenting data sets in a useful format, to include proficiency in MS Office suite of programs
  • Working knowledge of state and federal healthcare programs available to participants and their dependents during periods of ineligibility and at retirement; general to advanced understanding of the healthcare marketplace and related regulations   
  • Willingness to research emerging topics and gain additional interpretation and understanding on specific rules and regulations; if needed, to read documents (large and small) in a timely manner
  • Ability to summarize complex and lengthy information for presentation to a small group
  • Ability to analyze processes and make constructive and considerate recommendations for improvement

Hours of Work and Compensation

Hours of Work:

  • Monday through Friday, 8:00 a.m. to 4:30 p.m.; Saturday, infrequently and with significant advanced notice


  • Occasionally required for industry education and training


  • Competitive and commensurate with experience, knowledge and skills


  • Employer-paid health, dental, vision, and prescription drug coverage
  • Employer-paid HRA
  • Participation in employer-paid defined benefit pension programs
  • Annual paid personal (sick/vacation) time

Notes to Applicants

Individuals with significant multi-employer claims processing experience but who have a limited background in plan participant servicing are still encouraged to apply.

This position will be filled following a multi-step interview process.

How to Apply

Cover letters and resumes may be submitted to and will be kept strictly confidential, if requested. 

This ad has been viewed 823 times. It expires on 3/19/2018.

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