Job Title: Medical Claims Examiner
Location: Chicago, IL 60608
Work Schedule: On-site, Monday – Friday, 37.5 hours per week (start times between 7:00 AM – 6:00 PM)
Job Type: Temp to Hire (Hybrid schedule once brought on permanently)

LHH Recruitment Solutions is partnering with a client in the Chicago area seeking a Medical Claims Examiner on a Temp to Hire basis. The role starts onsite and transitions to a hybrid schedule once permanent.

Key Duties and Responsibilities:

• Process medical and facility claims accurately and in a timely manner, ensuring all required information is included, such as accident details, subrogation forms, other insurance data, referrals, pre-certifications, repricing, and audits.

• Review provider reconsiderations and either reprocess the claim or generate response letters as needed.

• Address inquiries from coworkers or other departments via email or a ticketing system

• Participate in check-run cycles and audits when assigned.

• Perform audits of auto-adjudicated claims and troubleshoot system configuration issues.

• Attend meetings with vendors, providers, and other partners as assigned.

• Monitor pended claims to avoid delays and maintain consistent processing times across plans.

• Correspond with providers, members, and external vendors via mail, email, or phone as necessary.

• Participate in departmental meetings, training sessions, and task force or committee meetings to address trends, questions, and potential process improvements.

Job Requirements:

• Minimum of five (5) years of experience in medical PPO and HMO claims processing and health insurance.

• Meet or exceed 98% financial and 95% procedural standards for quality and production.

• Proficiency in medical claim processing, subrogation, ICD-10, CPT, HCPC Codes, HCFA 1500, and UB-02 claim forms.

• Strong knowledge of plan documents and insurance policies.

• Data entry experience.

• Basic computer and keyboarding skills.

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.lhh.com/us/en/candidate-privacy

The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance