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Claims Representative II

The Judge Group Elmhurst Full-Time
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Our client is currently seeking a Claims Representative II Oak Brook, IL

This job will have the following responsibilities:
  • Handles written response to incoming reconsideration requests from providers and outside agencies. 
  • Enters provider demographic and contract affiliation information into the health plan system. 
  • Researches and documents inquiries and proactive research in a thorough, professional and expedient manner. 
  • Completes appropriate documentation for tracking/trending data. 
  • Composes correspondence to reflect accurate resolution information in a clear, concise, grammatically correct format. 
  • Maintains tracking system of correspondence and outcomes of request; maintain organized and accurate files. 
  • Monitors each request to ensure all internal and regulatory timelines are met. 
  • Communicates with Provider Service Representatives regarding relevant provider issues. 

Qualifications & Requirements:
  • Knowledge of medical terminology, CMS claims coding guidelines, and Provider Contracts 
  • Comprehensive knowledge of healthcare customer service 
  • Good MS Office knowledge (Outlook, Word, and Excel) 
  • Ability to type 40 WPM 
  • Strong organizational skills 
  • Excellent problem-solving skills 
  • Ability to work in multi-disciplinary teams and the ability to perform independently while handling multiple projects simultaneously 
  • Excellent verbal and written communication skills
  • Ability to abide by Molina's policies 
  • Ability to maintain attendance to support required quality and quantity of work 
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) 
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers 
  • High School Diploma or equivalent GED 
  • 2-4 years experience in a managed care setting. 
  • CPT and ICD-9 coding, data entry, and 10-Key experience.

Skills required

Accounts Receivable
Casualty Insurance
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Job ID: 599260


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The Judge Group is a privately owned, leading professional services firm with nearly 50 years of experience in providing technology, talent, and learning solutions. Our services are successfully delivered through a network of more than 35 offices in the United States, Canada, and India. The Judge Group serves more than 47 Fortune 100 companies and is responsible for 7,000 professionals on assignment annually across a wide range of industries.

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