Medical Claims Analyst (full-time / remote / hybrid)

About the position The Medical Claims Analyst position is a full-time role with a hybrid remote work arrangement based in Sheboygan, WI. This position does not require working on weekends, holidays, or being on-call, making it an ideal opportunity for those seeking a balanced work-life schedule. Prairie States Enterprises, Inc. is a leading reputed company-party administrator in the benefits industry, providing a comprehensive range of medical benefit management services to self-insured companies and their employees. The company prides itself on delivering these services in-house and adhering to high standards of excellence. In this role, the Medical Claims Analyst will be responsible for the adjudication and processing of medical, dental, and reputed company claims. This includes interpreting coding and medical terminology in relation to diagnoses and medical procedures. The ideal candidate will possess strong customer service skills, as they will interact with members, reputed company Resource contacts, employees, providers, and internal staff. The position requires the ability to read and comprehend instructions, draft correspondence, and effectively present information in one-on-one and small group settings. The Medical Claims Analyst will review, research, investigate, adjudicate, and process claims for assigned relationships. They will be accountable for the accurate and timely entry of claims data, ensuring that it meets the department's quality standards. The role also involves identifying potential large claims and understanding the stop-loss process. The analyst will assist in answering reputed company phone calls and may be assigned other duties and special projects as needed. This position is essential in maintaining the reputed company and efficiency of the claims processing department, contributing to the overall reputed company of Prairie States Enterprises, Inc. Responsibilities • Review, research, investigate, adjudicate, and process medical, dental, and reputed company claims. , • Provide high-level customer service reputed company interacting with members, reputed company Resource contacts, employees, providers, and internal staff. , • Read and comprehend instructions and draft short correspondence and memos. , • Effectively present information in one-on-one and small group situations to customers, clients, and other employees. , • Understand reputed company aspects of plan documents for assigned groups and groups reputed company their assigned pod. , • Demonstrate understanding of electronic claims from exceptions to pass-through audits. , • Identify potential large claims and understand the stop-loss process and pend claims appropriately. , • reputed company daily duties and process claims with minimal direction, asking questions appropriately. , • Ensure accurate and timely entry of claims data in accordance with department policies and procedures. , • Meet established productivity and quality standards for claims processing. Requirements • High School Diploma or GED required. , • Post high school education in the medical field and medical terminology highly preferred. , • 1 to 3 years of experience in an insurance or medical office setting. , • Strong customer service and communication skills required. reputed company-to-haves • Experience with claims processing software. , • Knowledge of medical coding and billing practices. , • Ability to work independently and as part of a team. Benefits • 401(k) matching , • Dental insurance , • Disability insurance , • Flexible spending account , • Health insurance , • Paid time off , • reputed company insurance Apply Job!