Complex Claims Lead

El Paso, United StatesOn-SiteFull-timePosted 1w ago

Job description

ABOUT US
Assured Benefits Administrators, Inc. (ABA) is a full-service third-party administrator, or TPA, providing flexible and fully integrated healthcare administration and management solutions across the United States since 1985. We are part of an international healthcare group with more than 35 years of industry experience, and we’re fully integrated with our long-term partners, who are recognized as industry leaders.
ABA is a certified “Great Place to Work”, united by a single mission: standing with members through every moment and milestone in their healthcare journey. With decades of industry experience and a team driven by passion, integrity, and excellence, ABA is committed to delivering connected, transparent, and innovative healthcare solutions to employers and members across the United States.
POSITION SUMMARY
As a Claims Processor, you will play a pivotal role in ensuring the efficiency and accuracy of claims processing within our organization. Your responsibilities will encompass a wide range of tasks, including year-end processing, managing adjustments, coordinating benefits, handling subrogation and high-dollar claims, processing Medicaid claims and complex appeals, and engaging in hospital audits. 

ESSENTIAL DUTIES AND RESPONSIBILITIES
The essential functions include, but are not limited to the following:

Year-End Processing: Oversee and facilitate the year-end processing activities to ensure timely and accurate closure of claims records. 
Adjustments Management: Process adjustments to claims as needed, ensuring proper documentation and adherence to company policies and procedures. 
Coordination of Benefits: Manage coordination of benefits for claims. 
Subrogation and High-Dollar Claims: Handle subrogation claims and high-dollar claims, applying sound judgment and attention to detail in reviewing and processing these complex cases. 
Medicaid Claims and Complex Appeals: Process Medicaid claims and assist in handling complex appeals, demonstrating a thorough understanding of Medicaid regulations and procedures. 
Hospital Audits: Conduct hospital audits to ensure compliance with contractual agreements and regulatory requirements. 
Case Management Reports: Analyze case management reports and make sure they are filed to the correct member.

MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)
Associate degree preferred; equivalent combination of education and experience considered.

Minimum of 1-3 years of experience in claims processing or related field. 
Strong understanding of claims processing procedures, including familiarity with medical terminology and insurance policies 
Highly detail-oriented with a focus on accuracy and quality assurance in claims processing 
Strong analytical and problem-solving skills with the ability to identify root causes and develop solutions. 
Experience handling escalated issues and making sound decisions under pressure.

OTHER DETAILS
Supervisory Responsibilities

None

Job details are sourced from the employer's original posting.

Open job posting

About the company

Aba

The American Bankers Association is the banking industry's champion.

View all Aba jobs

Industry: Banking
Open roles: 44