Medical Claims Coordinator

Job Summary

A company is looking for a Medical Claims Coordinator to support healthcare operations by auditing and adjudicating medical stop loss claims.

Key Responsibilities

• Review and audit medical stop loss claims for compliance with plan documents and contracts
• Collaborate with finance to facilitate approved claim payments and communicate decisions with third-party administrators
• Monitor claim trends, generate reports, and perform self-audits to improve accuracy and efficiency

Qualifications

• High School Diploma or GED required; Bachelor's degree in Medical Billing and Coding or related field preferred
• Minimum 5 years of experience in medical claims administration
• Familiarity with medical terminology and third-party administration processes
• Proficiency in Microsoft Office and relevant computer applications
• Strong organizational and analytical skills