Claims Processor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims Processor based in United States.

This role plays a key part in ensuring accurate and timely processing of health and welfare claims while delivering high-quality customer service to members and plan participants. You will work within established plan guidelines, regulatory requirements, and internal policies to adjudicate a variety of benefit claims. The position requires attention to detail, consistency, and a strong understanding of benefits administration principles. You will also interact with members and stakeholders to respond to inquiries and resolve routine issues. Operating in a structured but fast-paced environment, you will manage multiple priorities while maintaining accuracy and confidentiality. This is a service-driven role where precision, integrity, and responsiveness directly impact member experience.

• Process routine health and welfare claims, including medical, dental, vision, prescription, life, AD&D, disability, and other benefit-related claims in accordance with plan guidelines and regulatory requirements.
• Apply knowledge of benefit plans and adjudication procedures to ensure accurate and timely claims payment decisions.
• Respond to customer inquiries via phone, written, electronic, or in-person communication, ensuring clear documentation and resolution.
• Maintain confidentiality and appropriate handling of protected health information (PHI) and personally identifiable information (PII).
• Interpret benefit plans, technical procedures, and regulatory materials to support accurate claims processing.
• Perform calculations related to benefits, including percentages, discounts, and other financial figures as required.
• Support additional administrative or operational tasks as assigned.

Requirements

This role requires foundational experience in claims processing or benefits administration, combined with strong communication skills and the ability to work accurately in a detail-oriented, regulated environment. Candidates should be comfortable managing shifting priorities while maintaining service quality and compliance standards.

• High school diploma or GED required.
• Minimum of 6 months of experience in health and welfare claims processing.
• Basic understanding of claims adjudication principles, medical/dental terminology, and coding systems such as ICD-10 and CPT-4.
• Strong attention to detail with a high level of integrity and commitment to customer service.
• Excellent verbal and written communication skills.
• Ability to read, interpret, and apply business documents, benefit plans, and regulatory guidelines.
• Proficiency with Microsoft Office and general computer systems.
• Strong organizational skills with the ability to manage multiple tasks in a fast-paced environment.
• Preferred: experience working within a third-party administrator environment.

Benefits

• Competitive compensation package aligned with experience and industry standards.
• Health, dental, and vision insurance coverage.
• 401(k) retirement savings plan with company matching contributions.
• Paid time off (PTO) and holiday benefits.
• Opportunities for professional development and career growth.
• Supportive work environment with a focus on teamwork and employee engagement.
• Additional well-being and employee assistance resources.