Medical Claims & Billing Analyst - In Office
About The Position
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don’t just process claims—we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are seeking a detail‑oriented Medical Claims & Billing Analyst with hands‑on experience in health insurance claims , preferably on the payment side . In this role, you’ll process medical, dental, and prescription drug card claims accurately and efficiently while interpreting plan documents and ensuring compliance with client contracts. This is an excellent opportunity for someone who understands the fundamentals of claims processing, billing practices, EOBs, and medical terminology — and who thrives in a collaborative, fast‑paced, in‑office environment.
Requirements
- High school diploma or equivalent
- 1+ year of experience in health insurance claims processing (payment or adjudication experience strongly preferred)
- Working knowledge of claims workflows, billing standards, medical terminology, and EOBs
- Knowledge of medical terminology is helpful
- Proficiency in Microsoft Office programs
- Strong communication skills (oral and written)
- Strong analytical and problem‑solving skills
- Ability to prioritize, organize, and work independently in a fast-paced environment
- High attention to detail and accuracy
- Reliable attendance and responsiveness to client needs
Nice To Haves
- Medical coding experience
- Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required
- Customer-focused mindset with the ability to build positive relationships
- Experience with self‑funded plans or Third Party Administrator (TPA) environments
- Knowledge of CPT, ICD‑10, HCPCS, and industry billing standards
Responsibilities
- Review and process medical, dental, and prescription claims accurately and on time using our claims system.
- Interpret plan documents to answer coverage questions and resolve claim issues.
- Communicate with clients and healthcare providers to clarify benefits, resolve problems, and ensure smooth claim handling.
- Provide clear and timely updates to clients about claim status and coverage details.
- Act as a resource for team members by answering questions and assisting with training for new staff.
- Audit claims for accuracy and collaborate with internal teams or external auditors when needed.
- Identify and correct overpayments or errors by coordinating with clients and providers.
- Maintain compliance with client contracts and company standards throughout the claims process.
Benefits
- 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year
- Comprehensive benefits : Medical, Dental, Vision, Life, and Disability Insurance
- Retirement plans : 401(k) and Employee Stock Ownership Plan (ESOP)
- Career growth : Internal training and advancement opportunities
- Culture : A supportive, team-based work environment
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
