MagnaCare is seeking experienced Healthcare Claims Examiners who are skilled in interpreting hospital and ancillary contracts, applying medical policies, and adhering to payment procedures. This role requires attention to detail, critical thinking, and a strong ability to manually process claims in alignment with established policies and procedures. This position is hybrid and may require work from the office on a consistent basis.
Primary Responsibilities
Review and adjudicate claims submitted for reimbursement that fall outside auto adjudication standards on a daily basis, ensuring compliance with quality, productivity, and timeliness requirements.
Apply medical policies, contractual provisions, and operational procedures to ensure precise adjudication and adjustments.
Generate correspondence, such as letters and questionnaires, to gather additional information from customers and providers; may also initiate phone inquiries.
Collaborate with Customer Service to address and resolve customer inquiries and concerns effectively.
Research and resolve client inquiries and escalations in a timely manner, collaborating with internal teams as needed to ensure effective resolution.
Execute client-requested claim adjustments and provide clear, concise written responses to client inquiries within established deadlines.
Perform in-depth research on account receivables and spreadsheets that require claim adjustments, delivering thorough and clarifying responses to providers and clients.
Demonstrate adaptability and willingness to provide backup support across various departments and roles as needed.
Essential Qualifications
Strong knowledge of healthcare contracts, medical terminology, and claims processing procedures.
Prior experience processing claims is required.
Minimum 1 year of experience in medical billing, claims adjudication, or a related role.
Excellent written and verbal communication skills, with the ability to manage inquiries professionally and efficiently.
Strong analytical skills, with the ability to research and resolve complex claim issues.
Proficiency in Microsoft Office Suite (Word and Excel).
Ability to meet production and quality standards while managing multiple priorities.
Strong problem-solving skills, with the ability to maintain professionalism under pressure.
At MagnaCare LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect, and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.
For more than 30 years, MagnaCare LLC has been a trusted partner in delivering flexible, customized solutions for self-insured organizations. As a national third-party administrator (TPA), we combine proprietary technology, network expertise, and a deep understanding of labor to help our clients achieve their goals while supporting the people they serve.
Our focus on labor means we work closely with funds, Taft-Hartley Trusts, and other self-insured groups to deliver tailored solutions that go beyond the basics. From health plan administration and eligibility management to contribution accounting, we provide the tools and support organizations need to succeed. With specialized offerings such as flexible network administration, direct contracting, in-house medical and care management, and workers’ compensation programs, we create benefit plans that address unique needs with precision.
