Claim Processor

Job Summary
We’re looking for a detail-oriented, self-motivated Claims Processor to join our team. In this role, you’ll review, adjudicate, and resolve a high volume of provider and member claims across all lines of business. Working within Level-Funded, TPA (Third Party Administrator), and ASO (Administrative Services Only) arrangements, you’ll ensure claims are processed accurately, on time, and in compliance with plan documents, employer requirements, and regulatory standards.

HERE’S WHAT YOU’LL DO IN THIS ROLE:

• Process a large daily volume of claims with accuracy and efficiency.
• Review and apply plan designs, stop-loss provisions, and benefit rules.
• Verify member eligibility and coverage across multiple employer groups.
• Apply knowledge of CPT, ICD-10, HCPCS, and other coding standards.
• Resolve discrepancies, errors, and incomplete claim submissions.
• Communicate with providers, members, and employer groups to gather information.
• Maintain compliance with HIPAA, ERISA, and self-funded plan regulations.
• Support audits, reporting, and process improvements.

HERE’S WHAT WE ARE LOOKING FOR:

• High school diploma or equivalent
• 2+ years of experience processing high-volume health insurance claims, preferably in a TPA, ASO, or self-funded plan environment.
• Solid understanding of medical terminology, coding standards (CPT, ICD-10, HCPCS), and claims adjudication systems.
• Familiarity with ERISA, HIPAA, and other regulations governing self-funded health plans.
• Proven ability to process claims quickly and accurately while meeting strict turnaround times.
• Strong analytical and problem-solving skills with attention to detail in high-volume work.
• Tech-savvy with proficiency in Microsoft Office and claims processing platforms.

HERE’S WHAT WE OFFER:

• 5% annual bonus based on company profitability

• Affordable health, vision, and dental insurance for you and your family

• Company contributes up to $2,300 to Health Savings Account annually

• Wellness program that contributes additional money towards your HSA

• Automatic 3% contribution into retirement plan

• Career development and growth opportunities

• 15 days of PTO & 10 paid holidays per year

MotivHealth is a growing insurance company that takes an innovative approach to creating and administering customized insurance plans that lower the cost of providing benefits, while increasing access to high quality healthcare.

We are an Equal Opportunity Employer and welcome applicants from all backgrounds. Qualified candidates will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected characteristic under applicable law.