Medical Claims Processor

Datamark, Inc.•El Paso, TX

10d•Onsite

About The Position

Join the DATAMARK, Inc. Team as a Medical Claims Processor! Are you looking for an exciting opportunity where your attention to detail and problem-solving skills make a real impact? Do you thrive in an environment that requires critical thinking and strong judgment? If so, we have the perfect role for you! As a Medical Claims Processor at DATAMARK, you'll play a vital role in the success of our operations by ensuring accurate and efficient back-office support. We are seeking a detail-oriented and performance-driven Medical Claims Processor to support patients prescribed complex and high-cost drug therapies. In this role, you will be responsible for verifying insurance coverage, conducting research, and resolving coverage-related issues to ensure timely and accurate prescription processing. This is a back-office position that requires strong analytical skills, efficiency, and comfort with outbound calls to insurance providers and patients.

Requirements

Previous experience in insurance verification, benefits investigation, pharmacy operations, or healthcare administration preferred
Knowledge of medical insurance terminology (deductibles, copays, prior authorizations, etc.)
Strong attention to detail and ability to process high volumes of information accurately
Excellent reading comprehension and research abilities
Comfortable making outbound calls to resolve insurance or coverage-related issues
Strong problem-solving and critical-thinking skills
Ability to manage productivity metrics in a fast-paced environment
Basic computer proficiency and experience navigating multiple systems

Responsibilities

Verify insurance coverage for new and existing patients to support timely prescription fulfillment
Pull and review customer accounts to assess eligibility, benefits, and coverage limitations
Conduct detailed research across multiple systems and portals
Initiate and complete outbound calls (OB calls) to insurance companies, pharmacies, and other partners to resolve coverage issues
Accurately document findings, decisions, and next steps in internal systems
Meet or exceed productivity expectations while maintaining accuracy
Identify and escalate complex cases or discrepancies as appropriate
Support patients requiring specialty, high-cost, or complex therapies through thorough and timely insurance determination