MagnaCare is seeking experienced Healthcare Claims Quality Specialists 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 on-site in the office on a consistent basis.
Primary Responsibilities
Perform routine and complex audits of claim transactions processed within our Production and QA regions to validate results.
Execute detailed review of internal and external reporting.
Support quarterly claim audits and updates.
Assess the impact of configuration changes by processing claim adjustments, entering claims manually, and void-reissue of payment.
Support new client implementations by verifying that benefits and claims logic were loaded correctly.
Develop and prepare reporting results of findings from process audits and testing.
Assist in identifying the root cause of errors inline as system configuration vs. manual processing.
Help identify solutions for system issues impacting claim processing results.
Perform focus audits and create ad hoc reports and result summaries for management and/or client.
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 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 (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.
