Medical Claims Processor

Maestro Health

Medical Claims Processor

Charlotte, NC
Full Time
Paid
  • Responsibilities

    We are… an employee health & benefits company with a tech-meets-service platform that simplifies and personalizes how employees and employers' shop, enroll and live with their benefits. Our innovative technology makes it easy for employees to choose the right benefits plan while equipping HR with the tools they need through one partner, one service team, one platform, one portal.

    Maestronites are… brought together with a passion to disrupt the status quo by reimagining employee health and benefits. This passion has driven us to create the first complete platform that optimizes the entire benefits experience for everyone. Our people, passion and platform are united by our mission: to make employee health & benefits people-friendly again.

    WHAT YOU WILL BE DOING:

    Maestro Health Company is expanding our Medical Claims Processing team and are looking for experienced Medical Claims Examiners, who have a background working for a Third-Party Administrator (TPA) or for a Health Insurance Company. All while maintaining a high standard of quality and ensuring legal compliance.

    • Determine covered medical insurance benefits in accordance with the provisions of the plan document
    • Establish proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims
    • Document medical claims processes by completing forms, reports, logs, and records
    • Resolve medical claims by approving or denying; calculating benefit due; initiating payment or denial
    • Ensure legal compliance by following company policies, procedures, guidelines, as well as federal insurance regulations
    • Protect operations by keeping claims information confidential
    • Update job knowledge by participating in educational and training opportunities; reading any required professional publications
    • Accomplish organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments

    WHAT SUCCESS LOOKS LIKE

    • Average daily production of 160 claims
    • Monthly financial accuracy 99% or higher
    • Monthly procedural accuracy 97% or higher
    • Manage renewals for assigned groups
    • Adhere to our core values: Fun. Preparedness. Teamwork. Humility. Urgency. Bold Thought. Honesty.

    WHAT YOU NEED

    • Minimum 3+ years of experience as a TPA medical claims examiner or Health Insurance Company medical claims examiner.
    • ONLY EXPERIENCED MEDICAL CLAIMS EXAMINERS WILL BE CONSIDERED
    • A friendly, professional demeanor and the ability to excel in a team-oriented environment
    • Ability to prioritize your assigned groups based on claim volume, renewal dates and check cycles
    • Strong analytical and detail-oriented aptitude; a high degree of accuracy is required
    • Excellent communication and organizational skills
    • Ability to manage time effectively, set priorities and meet deadlines
    • Ability to learn and adapt to change
    • Desire/ability to work successfully in a small, entrepreneurial company environment
    • Healthcare related insurance experience is a significant plus

    WHY WORK AT MAESTRO HEALTH?

    We have great benefits:

    • Personal, Vacation and Sick Time
    • Medical and Prescription
    • Dental
    • Vision
    • Life and Disability
    • Health and Wellness programs
    • 401k with Employee Match
    • Figo – Pet Insurance
    • Kashable

    We have great perks in each of our offices, along with a fun, energetic and fast-paced environment, and what will really drive you is our vision. Maestro Health is making employee health & benefits people-friendly again by making healthcare easy to understand, tools easy to use, and costs easy to control. We are aiming to become a household name within the employee health & benefits space.

    We can't do that without great people. We want to hear “WOW! That was the best job and business experience I ever had!” from every Maestronite – past, present, and future. You should be personally challenged, laugh, work your tail off and look forward to coming to work.