Claim Processor - Hybrid - South Jordan, UT

MotivHealth Insurance Company • South Jordan, UT

3d • Hybrid

About The Position

We’re looking for a detail-oriented, self-motivated Claims Processor to join our team. In this role, you’ll review, adjudicate, and resolve a high volume of provider and member claims across all lines of business. Working within Level-Funded, TPA (Third Party Administrator), and ASO (Administrative Services Only) arrangements, you’ll ensure claims are processed accurately, on time, and in compliance with plan documents, employer requirements, and regulatory standards.

Requirements

• High school diploma or equivalent
• 2+ years of experience processing high-volume health insurance claims, preferably in a TPA, ASO, or self-funded plan environment.
• Solid understanding of medical terminology, coding standards (CPT, ICD-10, HCPCS), and claims adjudication systems.
• Familiarity with ERISA, HIPAA, and other regulations governing self-funded health plans.
• Proven ability to process claims quickly and accurately while meeting strict turnaround times.
• Strong analytical and problem-solving skills with attention to detail in high-volume work.
• Tech-savvy with proficiency in Microsoft Office and claims processing platforms.

Responsibilities

• Process a large daily volume of claims with accuracy and efficiency.
• Review and apply plan designs, stop-loss provisions, and benefit rules.
• Verify member eligibility and coverage across multiple employer groups.
• Apply knowledge of CPT, ICD-10, HCPCS, and other coding standards.
• Resolve discrepancies, errors, and incomplete claim submissions.
• Communicate with providers, members, and employer groups to gather information.
• Maintain compliance with HIPAA, ERISA, and self-funded plan regulations.
• Support audits, reporting, and process improvements.

Benefits

• 5% annual bonus based on company profitability
• Affordable health, vision, and dental insurance for you and your family
• Company contributes up to $2,300 to Health Savings Account annually
• Wellness program that contributes additional money towards your HSA
• Automatic 3% contribution into retirement plan
• Career development and growth opportunities
• 15 days of PTO & 10 paid holidays per year

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED