Claims Examiner (Remote)

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, then Health Plans Inc. is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you.

What we do

HPI is unique. A respected industry leader that’s been serving customers for over 40 years, we’re known for our innovation and growth. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you’ll contribute to ideas that make a real difference for employers and employees nationwide. There isn’t a challenge we won’t accept and we’re looking for people who have a passion to take it on. Not just a job—a mission.

What you’ll do

We’re looking for an organized and detailed individual with a background in medical billing and coding to join our Claims Operations team. In this role you’ll process medical claims according to our clients’ varying medical benefit plans. After successfully completing training, you’ll be assigned to a specific block of group plans. In additional to gaining authoritative knowledge of those client plan benefits, your expertise will support the client/customer relationship as you assist members, provider and clients with questions regarding their claims and/or policies. 

In this role, you’ll also:

• Maintain quality and production levels as determined by management 
• Maintain updated filings for claim benefit investigation (medical necessity reviews, etc.) as required in accordance with plan benefits 
• Prepare filings for outside vendors (subrogation) as required in accordance with the plan benefits
• Handle correspondence from Plan Correspondent and/or employees in a timely and efficient manner 
• Resolve claim issues that do not require outside involvement 

What you bring: 

• A High School Diploma or equivalent; prior experience in claims processing 
• The ability to work independently and as part of a team
• The ability to prioritize tasks, work within timeframes and meet deadlines 
• The ability to recognize and maintain confidentiality, and communicate in a professional manner. 
• Proficiency with Microsoft Word and Excel

Bonus points if you have: Knowledge of medical terminology and/or billing and coding (preferred) 

Why choose us?

• Our space is a reflection of who we are—innovative, open and collaborative.
• Love to get creative? We do too. Brainstorm in one of our team break-out rooms.
• We think feeling your best is an important factor in producing great work, so we embrace a “smart casual” dress code and work at ergonomic desks. 
• Need to reenergize? Take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms. 
• We offer our employees flexible work arrangements including remote and hybrid options (depending on the position)
• We’re a people-first company and value giving back to our community. Ask us about our RISE Committee & and volunteer opportunities.

Benefits

We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you!  We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life. Check out some of the benefits we offer to our employees:

• Medical, Dental and Vision Coverage
• Prescription Drug Coverage
• Fitness Reimbursement Benefit
• Tobacco Cessation Program
• Employee Assistance Program
• Flexible Spending Account & Health Savings Account
• 401(k) and Profit-Sharing Plan
• Quarterly Bonuses
• Generous Paid-Time Off 
• Volunteer Days
• Education Assistance & Professional Development Opportunities
• ….and much much more!

So, think you want to join the HPI team? We hope to hear from you!

You can read more about us at hpitpa.com/about-us/careers/

EEO/AA/M/F/Vet/Disability Employer