ABOUT YOU
You thrive in a fast-paced environment. You’re curious and have an eye for detail. You strive to exceed expectations, and succeed. You’re excited by the opportunity to join a fast-growing company with unlimited opportunities for growth & competitive benefits. Does this sound like you? If so, Boon-Chapman could be the place for you!
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ABOUT US
Boon-Chapman is not your average Third Party Administrator. In addition to traditional TPA services, Boon-Chapman administers business process outsourcing for insurance entities, and other services through its sister companies. With nearly 55 years in business, Boon-Chapman combines the legacy of a family-owned-and-operated company, with the energy and potential of a fast-growing enterprise of companies. A few of our benefits include:
- Paid holidays & competitive PTO that increases with tenure
- Full benefits package including healthcare, dental, vision, paid STD & life
- Casual everyday dress
- Access to an on-staff Medical Director for employees and their family members
- Unlimited opportunities for growth – success is in your own hands
JOB RESPONSIBILITIES
As a Medical Claims Analyst you’ll be responsible for determining eligibility of claims under major medical and self-insured plans, investigating charges, explaining payment or denials to claimants, and more. Key responsibilities include:
- Communicates internally & externally with clients, participants, brokers, agents, & more
- Analyzes claims to determine eligibility, medical facts, contract coverage & limitations
- Determines when to pay or deny claims, or request additional information
- Calculates payment of benefits in accordance with coverage information, contract language or plan document & medical documentation
- Screens all charges for reasonableness of costs & medical necessity
- Investigates excess or questionable charges by letter or telephone
- Determines possibility of coordination of benefits (COB) on each claim & calculates benefits accordingly
- Investigates claims by contacting doctors, hospitals & other provides
- Corresponds with claimants, healthcare providers, & others to explain payment of benefits, denials & delay in payments
WHAT WE'RE LOOKING FOR (NOBODY'S PERFECT BUT EXPERIENCE IS A PLUS)
- High school diploma or equivalent
- Experience & education may be substituted for one another
- Knowledge of CPT, HCPCS, IC9 coding
- Knowledge of claims processing & the Eldorado system (preferred)
- Skilled in customer service, with strong communication skills (interpersonal & written)
- Good at problem solving and analyzing information
- Able to adapt to a constantly changing environment & multitask
- Able to accurately compile data, perform detailed work & maintain confidential information
- Able to meet deadlines
- Able to maintain attendance & present a professional appearance & demeanor
- Able to work well with others
