Claims Processor

National Healthcare Solutions Group LLC • El Paso, TX

1d

About The Position

As a Claims Processor at Assured Benefits Administrators, Inc. (ABA), you will help ensure the efficiency and accuracy of claims processing. The role covers year-end processing, claims adjustments, coordination of benefits, subrogation and high-dollar claims, Medicaid claims and complex appeals, hospital audits, and case management reports. You will also perform other job-related duties as assigned. The position has no supervisory responsibilities and no travel requirements.

Requirements

• At least 1–3 years of experience in claims processing or a related field.
• Strong understanding of claims processing procedures, including familiarity with medical terminology and insurance policies.
• High attention to detail and a focus on accuracy and quality assurance in claims processing.
• Strong analytical and problem-solving skills, including the ability to identify root causes and develop solutions.
• Experience handling escalated issues and making sound decisions under pressure.

Nice To Haves

• Associate degree preferred; an equivalent combination of education and experience is considered.

Responsibilities

• Oversee and facilitate year-end processing to ensure timely and accurate closure of claims records.
• Process claims adjustments, ensuring proper documentation and adherence to company policies and procedures.
• Manage coordination of benefits for claims.
• Handle subrogation and high-dollar claims, reviewing and processing complex cases with sound judgment and attention to detail.
• Process Medicaid claims and assist with complex appeals, applying an understanding of Medicaid regulations and procedures.
• Conduct hospital audits to ensure compliance with contractual agreements and regulatory requirements.
• Analyze case management reports and ensure they are filed to the correct member.
• Perform other job-related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree