Medical Claims Specialist

JOB TITLE: Payroll Specialist

LOCATION: Madison (53714)

COMPENSATION: $18-21/hour

OVERVIEW:

Our client is looking to add a Claims Processing Specialist to their Madison (East Side) office.

The Claims Specialist is responsible for processing and auditing vendor claims to ensure accurate and timely processing. A Claims Specialist is able to use payroll software with accuracy and efficiency. The Claims Specialist must have strong analytical and critical-thinking skills to review and authorize claim payment and investigate unusual claims with strong attention to detail. The Claims Specialist possesses excellent communication abilities for engaging with participants, vendors, and colleagues. A commitment to upholding elevated standards of precision and efficiency will directly support our client’s mission of delivering outstanding service to both participants and providers.

Our client is a mission-driven organization that offers administrative services to empower individuals in taking control of their personal care services. They strive to ensure that individuals receive high-quality and comprehensive care with minimal interruptions. The organization enables individuals to make choices and manage their own care programs, including deciding on the how, when, where, and who delivers these services. By facilitating self-directed home and community-based services, our client significantly enhances the quality of home care available to aging seniors and individuals with special needs.

RESPONSIBILITIES:

· Resolve claims in a timely manner through participant/vendor service calls and communications.

· Administer statements of payment to personnel electronically.

· Research and problem-solving.

· Audit claims process via quality control tests, random inspections, and writing reports documenting process issues.

· Maintain a filing system to securely retain all records and supporting reporting.

· Prepare and execute pay orders and administer statements of payment electronically.

· Maintain accurate records of payees, payments, and budgets for reporting purposes.

· Prepare and execute pay orders through an electronic system or distribute payments.

· Administer statements of payment to personnel either electronically or on paper

· Analyze and investigate vendor claims to help prevent fraud.

· Prepare reports for upper management, finance department etc.

· Performs other duties as assigned or needed.

QUALIFICATIONS:

· Ability to effectively use computer software including Microsoft Outlook, Word, Excel and HR software

· General math, clerical, data entry, and customer service.

· Experience as payroll specialist.

· Proven experience in Claims auditing or processing.

· Knowledge of legislation and regulations of the field.

· Trustworthy with attention to confidentiality.

· Outstanding organizational ability with great attention to detail.

· Excellent communication skills.

· High school diploma or equivalent; BSc/BA in business, accounting or relevant field is a plus.

Equal Employer Opportunity Statement

We are an equal opportunity workplace, committed to equal employment opportunity regardless of race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, genetic information, veteran status, gender identity or expression, sexual orientation, or any other characteristic protected by applicable federal, state, or local law. We are committed to diversity, equity, and inclusion, both in our hiring practices and in our experiences as a teammates. We strive to create a mindful and respectful environment where everyone can bring their authentic self to work, and experience a culture that is free of harassment, racism, and discrimination.

Disclaimer:

This job description indicates the general work necessary to adequately execute core job responsibilities. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of teammates assigned to this job.