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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:

Education:

  • High School Diploma or GED

Experience:

  • 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:

Education:

  • 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

Experience:

  • 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

Travel:

  • Occasionally required for industry education and training

Salary:

  • Competitive and commensurate with experience, knowledge and skills

Benefits:

  • 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 jobs@pdc30.com 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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