Sr. Medical Claims Examiner Representative

Motion Picture Industry Pension & Health Plans (MPI)•Los Angeles, CA

About The Position

For more than 70 years, the Motion Picture Industry Pension & Health Plans (MPI) has proudly served the entertainment community by supporting the financial and healthcare well-being of the people who bring stories to life — from set crews to post-production pros. We’re not just analysts and benefit specialists; we’re problem-solvers, collaborators, and stewards of trust. Our teams are guided by a simple mission: to improve the lives of those who work in the entertainment industry through accuracy, accountability, and care. MPI is recognized as a five-time certified Great Place to Work® employer and recipient of the World at Work Seal of Distinction because we believe people do their best work when they’re respected, supported, and inspired. MPI is seeking a Senior Medical Claims Examiner/ Representative. The Examiner/Representative reviews and processes escalated health claims for reconsideration, confirms accumulator benefits to outside vendors, and communicates (by phone, email, and written correspondence) with participants and providers’ offices about claims and benefit issues.

Requirements

High school Diploma or GED required.
Minimum 2 years verifiable claims processing experience with quality average of 95%.
Knowledge of: CPT, HCPCs, ICD-9, COB, and Medical Terminology.
Intermediate level of proficiency in PC skills including MS Word, Outlook, and Excel
Previous customer service/call handling experience in a health care environment.
Familiarity with QNXT configuration.
Clear and effective oral and written communication skills.
Excellent attendance & reliability with the ability to work overtime/extended hours as needed.
Strong organizational skills and attention to detail
Ability to handle fast-paced work while meeting production and quality assurance goals/standards
Good interpersonal skills; able to interact with individuals at all levels.
Ability to accept direction and developmental guidance from lead and manager.
Flexible team player, with a positive, cooperative, and helpful attitude; willing to assume additional duties as needed.

Nice To Haves

Some college preferred.
Knowledge of MPI Plan benefits.
Working knowledge of Anthem WGS Claims system.
In-depth knowledge of V3 Eligibility system.

Responsibilities

Review and process requests for claim adjustments including responses to providers and participants.
Process a high volume of complex or technically difficult claims.
Perform investigation / research as needed for the processing of medical claims.
Make outbound calls to MPI participants and/or providers regarding the status of a claim.
Contact providers regarding misrouted or unidentified claims.
Contact providers requesting additional information (medical records, consultation notes, progress notes and prescriptions).
Actively execute appropriate claim activities to ensure consistent quality/configuration of claims processing.
Document issues and actions effectively and efficiently utilize internal systems.
Test configuration changes.
Participate in development and maintenance of departmental procedures.
Provide accumulator benefits to MPI external medical partners.
Complete other duties as assigned including, but not limited to, assisting other departments and units as needed.