Healthcare

Medical Claims Administration

Contract

Strategic Staffing Solutions

STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING!

Strategic Staffing Solutions is currently looking for a Medical Claims Consultant for a contract opportunity with one of our largest clients located in Detroit, MI!

Title: Medical Claims Administration

Location: Detroit, MI (Remote/must be local to Michigan)

Duration: 12+ months

Role Type: W2 contract engagement

Pay Rate: $25-29/hour

What are the 3-5 “must haves” in order to be successful in this role:

  • Strong MS Office skills, particularly MS Excel, Access, Outlook, Teams
  • Strong communication skills – being able to write emails to group professional and grammatically correct without errors
  • Time management – able to handle audits, responding to group emails, team emails, etc.
  • Healthcare experience

Job Responsibilities

  • Conduct comprehensive audits on group members to evaluate their health insurance coverage, encompassing medical, dental, vision, and hearing benefits.  
  • Integrate modified membership information into the database to ensure it is up to date and accurate.
  • Handle inquiries from groups regarding member healthcare coverage in a comprehensive manner.
  • Confirm the eligibility of members and ensure that their coverage is within the appropriate time frame of the group.
  • Verify that members in the internal systems align with the members listed in the group files. 
  • Investigate any discrepancies between coverage in the system and actual coverage of a member, and determine the appropriate course of action.
  • Confirm the eligibility of members by verifying that their provider/primary care physician (PCP) information matches that in the system. Verify that the PCP selected by the member is eligible to be a provider by checking the system using their National Provider Identifier (NPI).

Qualifications

  • High school diploma or GED required. Bachelor’s degree in related field preferred.
  • Must have strong Customer Service experience
  • MUST have strong Excel
  • Data analysis, data entry and analytical skills
  • Good Communication skills
  • Reporting skills
  • Experience with Charts and graphs is ideal
  • Experience with patient access or memberships or claims or EDI or benefits or Medicare or Medicaid, etc. 

The S3 Difference

The global mission of S3 is to build trusting relationships and deliver solutions that positively impact our customers, our consultants, and our communities.  The four pillars of our company are to:

  • Set the bar high for what a company should do
  • Create jobs
  • Offer people an opportunity to succeed and change their station in life
  • Improve the communities where we live and work through volunteering and charitable giving

As an S3 employee, you’re eligible for a full benefits package that may include:

  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • 401(k) Plan
  • Vacation Package
  • Life & Disability Insurance Plans
  • Flexible Spending Accounts
  • Tuition Reimbursement

Job ID: JOB-235374
Publish Date: 07 May 2024

Tagged as: Medical Claims Administration