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Lakeshore Talent is partnering with an innovative healthcare organization to find a Medical Claims Processor who can hit the ground running, manage provider inquiries with confidence, and navigate claims with precision. This role is perfect for someone looking to grow within the healthcare industry while maintaining a great work-life balance and flexibility.
- Immediate Start – We’re hiring ASAP!
- Pay: $20-$25/hr
- Location: Denver, CO
- Flexibility – Start on-site for 2 weeks, then transition to a hybrid schedule (2 days in-office).
- Supportive Team Environment – Work closely with an experienced and collaborative team, including the Legal and Provider Relations departments.
- Impactful Work – You’ll be a key player in ensuring providers and participants receive accurate, timely claims processing and resolution.
Responsibilities:
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Handle inbound calls from providers regarding claim statuses, benefits, billing, and payments.
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Process and audit medical, dental, and facility claims per CMS and NCCI guidelines using systems like Plexis, Virtual Examiner, ABCT, and Encoder Plus.
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Manage provider appeals, perform detailed claims research, and communicate resolutions clearly and professionally.
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Collaborate cross-functionally with departments to resolve complex issues and improve claims accuracy.
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Monitor and address pended claims, assist with claims audits, and process provider refunds.
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Assist providers with claim submissions and training, including navigating appeals and documentation requirements.
Requirements:
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3+ years of experience as a Claims Processor (or similar role in healthcare, clinic, or provider setting)
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Previous call center or high-volume inbound phone experience
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Strong communication and customer service skills
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Ability to type 10,000+ KSPH and draft professional correspondence
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Familiarity with multi-line phone systems, scanners, and general office equipment
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Associate’s Degree or Certificate in Healthcare Sciences, Health Info Tech, or a related field
Preferred:
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Experience with Medicare/Medicaid claims
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Medical billing/coding and familiarity with UB04, HCFA, and Dental forms
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Prior experience using Plexis, ABCT, Encoder Plus, or Virtual Examiner
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Spanish/English bilingual skills a plus
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Claims audit or appeals experience is highly desirable