Detego Health is a national Third Party Administrator (TPA) and level-funded plan sponsor offering self-funded and level-funded plan administration and reporting. We operate much like an independent accounting or law firm, providing “behind the scene” professional claims and benefit plan administration for our clients.

Claims Administration Supervisor supervises the administration of health insurance claims, payment processing, billing research, and responding to inquiries. Ensures the accurate and timely disposition of claims and resolves matters according to coverage limits and company procedures. Being a Medical Claims Lead requires providing guidance to staff on more complete or high-value claims. Reviews and resolves escalated issues. The Medical Claims Lead supervises a small group of para-professional staff in a department characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures.

Job Functions

• Leads team of claims processors.
• Ability to adjudicate and process medical claims, as needed.
• Audits claims to ensure accuracy and completeness.
• Trains new hires
• Analyzes insurance claims to prevent fraud.
• Prepares reports by collecting, analyzing, and summarizing information.
• Resolves claims by approving or denying based on documentation needs, calculating benefits due, and determining compensation settlement.
• Ensures legal compliance by following company policies, procedures, and guidelines, as well as state and federal insurance regulations.
• Maintains quality customer service by following customer services practices and responding to customer inquiries.
• Performs other duties as assigned

Qualifications

• High School Diploma or GED – Required
• 3 years’ experience in Medical Claims Processing – Required
• Medical Billing Entry experience
• Previous Lead and/or Supervisory experience preferred.
• Certified coder preferred

Job Type: Full-time

Pay: $27.00 - $32.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday
• No nights
• No weekends

Work setting:

• In-person
• Office

Work Location: In person