ABOUT YOU

You thrive in a fast-paced environment. You’re curious and have an eye for detail. You strive to exceed expectations, and succeed. You’re excited by the opportunity to join a fast-growing company with unlimited opportunities for growth & competitive benefits. Does this sound like you? If so, Boon-Chapman could be the place for you!

ABOUT US

Boon-Chapman is not your average Third Party Administrator. In addition to traditional TPA services, Boon-Chapman administers business process outsourcing for insurance entities, and other services through its sister companies. With nearly 55 years in business, Boon-Chapman combines the legacy of a family-owned-and-operated company, with the energy and potential of a fast-growing enterprise of companies. A few of our benefits include:

• Paid holidays & competitive PTO that increases with tenure
• Full benefits package including healthcare, dental, vision, paid STD & life
• Casual everyday dress
• Access to an on-staff Medical Director for employees and their family members
• Unlimited opportunities for growth – success is in your own hands

JOB RESPONSIBILITIES

As a Medical Claims Analyst you’ll be responsible for determining eligibility of claims under major medical and self-insured plans, investigating charges, explaining payment or denials to claimants, and more. Key responsibilities include:

• Communicates internally & externally with clients, participants, brokers, agents, & more
• Analyzes claims to determine eligibility, medical facts, contract coverage & limitations
• Determines when to pay or deny claims, or request additional information
• Calculates payment of benefits in accordance with coverage information, contract language or plan document & medical documentation
• Screens all charges for reasonableness of costs & medical necessity
• Investigates excess or questionable charges by letter or telephone
• Determines possibility of coordination of benefits (COB) on each claim & calculates benefits accordingly
• Investigates claims by contacting doctors, hospitals & other provides
• Corresponds with claimants, healthcare providers, & others to explain payment of benefits, denials & delay in payments
  

WHAT WE'RE LOOKING FOR (NOBODY'S PERFECT BUT EXPERIENCE IS A PLUS)

• High school diploma or equivalent
• Experience & education may be substituted for one another
• Knowledge of CPT, HCPCS, IC9 coding
• Knowledge of claims processing & the Eldorado system (preferred)
• Skilled in customer service, with strong communication skills (interpersonal & written)
• Good at problem solving and analyzing information
• Able to adapt to a constantly changing environment & multitask
• Able to accurately compile data, perform detailed work & maintain confidential information
• Able to meet deadlines
• Able to maintain attendance & present a professional appearance & demeanor
• Able to work well with others