TO APPLY: EMAIL YOUR RESUME TO JOBS@MAESTROHEALTH.COM
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 service team and looking for a Medical Claims Processor. The right candidate will serve medical insurance customers by determining insurance coverage, processing and resolving medical claims, documenting actions, maintaining quality customer services 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 and 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 and reading any required professional publications
- Accomplish organization goals by accepting ownership for accomplishing new and different requests and 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. Kindness. Bold Thought. Honesty.
WHAT YOU NEED
- 3+ years of experience as a TPA medical claims examiner
- 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
- Life and Disability
- Health and Wellness Programs
- 401k with Employee Match
- Figo – Pet Insurance
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.
Are you ready to become a Maestronite? Let’s do this.
Maestro Health is an equal opportunity workplace. We are committed to equal opportunity regardless of race, color, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability or veteran status.