Benefit Administrative Systems, LLC
  • Mokena, IL, USA
  • 18.00+
  • Full Time

Medical, Dental, Vision, 401(k), Life, Optional Life, AD &D, STD, LTC, LTD, Wellness, Vacation, PTO, Holiday,

Responsible for:

In this role, the incumbent will work under the supervision of the Claims Supervisor, focused on adjudication of Group Health Plan medical and dental claims utilizing employer and payer specific policies and procedures. Provide telephonic support to employer contact for issues related to claims status, claims adjudication questions, PPO information, provider status, and any basic questions regarding health coverage as stated in the employer's Plan Document.

Required/Preferred Skills:

Intermediate to advance knowledge of Microsoft Excel & Word; Hands-on experience with web-based computer systems

Ability to establish cooperative working relationships with staff and management team; interact with staff and vendors in a professional and courteous manner.

Expertise in researching and analyzing problems and developing and implementing solutions.

Able to anticipate and solve problems

Strong organizational skills and detail oriented

Excellent verbal communication skills

Capable of working in a team, as well as independently, and effectively in a deadline-driven environment


3+ years claims processing

Prior experience with Third Party Administrator

Prior experience with RIMS/Quiclink processing software

Knowledge of physician practice and hospital coding, billing, and medical terminology, CPT, HCSPCS, ICD-10-CM

Experience with UB/institutional (CMS-1450) and/or professional (CMS-1500) claims

Strong knowledge of Medicare billing and payment and coverage guidelines and regulations

Strong experience in the analysis and processing of claims, utilization review/quality assurance procedures, CMS payment methodologies(i.e., Medicare Physician Fee Schedule, Lab, DRG's, Outpatient prospective payments systems, ambulatory surgical center, ESRD, Ambulance, Anesthesia

Must be able to work with minimal supervision

Creative thinker with good skills a problem resolution specifically related to healthcare claim adjudication

Benefit Administrative Systems, LLC
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