Claims Processor
MMC

As a member of the Spending Accounts team, the Claims Processor is responsible for properly adjudicating our clients' consumer-driven health plan claims, in accordance with plan-specific policy provisions, to determine extent of company's liability, make approval or denial decisions, and negotiate settlements with claimants.

ESSENTIAL DUTIES AND RESPONSIBILITIES include, but are not limited, to the following:

• Apply general processing procedures and specific guidelines to correctly process claims;
  
• Review and interpret pending claims to determine the appropriateness of the claim status to take necessary actions within FSA policy provisions;
  
• Examine information including authorizations, payments, denials, and resolve outstanding issues to meet client expectations;
  
• Partner with the Spending Account Client Service Representatives to correct errors, rectify omissions, and investigate questionable issues;
  
• Explain rationale on claim adjustments, to appropriate internal and external parties, such as payments and denial decisions;
  
• Adhere to MMA East's internal and external compliance and security processes;
  
• Report daily production to Senior Claims Processors and Spending Accounts Team Manager;
  
• Assist with special projects as determined by Spending Accounts Team Manager.
  

• High school diploma or GED equivalency is required, Bachelor's degree preferred;
  
• Minimum of 1 year demonstrated claims processing experience;
  
• Experience within consumer spending health plans, such as flexible spending accounts, health reimbursement accounts, health savings accounts is required;
  
• Proficiency in the Microsoft Office Suite, including Word, Excel, PowerPoint, and Outlook is required;
  
• Experience within a third party administration, benefits brokerage, health and welfare consulting, health care, or insurance related industry is highly preferred.
  

• Strong organizational, analytical skills and strong attention to detail;
  
• Excellent troubleshooting, decision making and problem solving skills;
  
• Solid interpersonal, verbal and written communication skills;
  
• Ability to work well independently and as a team member;
  
• Ability to multitask and successfully operate in a fast-paced work environment;
  

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  
• While performing the duties of this job, the employee is:
  
  • Frequently required to sit; speak or hear; use hands to finger, handle, feel objects, and reach with hands and arms;
    
  • Occasionally required to stand and walk;
    
  • Extensive use of computer and keyboard and viewing of computer screen is required;
    
  • Specific vision abilities required by this job include vision, and ability to adjust focus.
    
• Other working conditions are normal for an office environment.
  

• Work is typically performed in a hybrid manner based out of our Conshohocken, PA, office