Job Overview: Lensa, a leading staffing and recruitment firm based in Plano, Texas, is seeking a detail-oriented Medical Claims Processor to join our remote team in the insurance category. In this pivotal role, you will handle the processing of medical insurance claims from submission to payment, ensuring compliance with regulations and payer guidelines. This position offers the flexibility of remote work, allowing you to contribute to efficient healthcare reimbursements while balancing professional and personal life. Key Responsibilities: Review incoming medical claims for completeness, accuracy, and adherence to policy terms, verifying patient eligibility and coverage details. Analyze claim documentation, including medical records, bills, and provider information, to determine appropriate reimbursement amounts. Code diagnoses and procedures using ICD-10 and CPT standards, resolving discrepancies or denials through investigation and communication with providers. Process approved claims for payment, update patient records in claims management systems, and generate reports on claim statuses and trends. Respond to inquiries from policyholders, providers, and internal teams, escalating complex issues to senior adjusters. Maintain strict confidentiality in handling sensitive health information per HIPAA regulations and contribute to process improvements for faster turnaround times. Required Qualifications: High school diploma or equivalent required; associate's or bachelor's degree in healthcare administration, medical billing, or related field preferred. Minimum of 2 years of experience in medical claims processing or billing within the insurance industry. Certification such as Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) is highly desirable. Proficiency with claims processing software like Availity, Change Healthcare, or similar systems. Skills: Exceptional attention to detail and analytical skills for reviewing complex medical claims. Strong knowledge of medical terminology, anatomy, and insurance policies including Medicare, Medicaid, and commercial plans. Excellent organizational and time management abilities to handle high-volume workloads. Superior communication skills, both written and verbal, for interacting with diverse stakeholders. Proficiency in Microsoft Office Suite, particularly Excel for data analysis, and adaptability to learning new software. Problem-solving mindset to resolve claim denials efficiently and a commitment to accuracy and compliance. Company Info: Lensa is an innovative recruitment platform connecting top talent with opportunities across industries, with a strong focus on insurance and healthcare. Headquartered in Plano, TX, we pride ourselves on a supportive, collaborative culture that values employee growth and work-life balance. Our remote-first approach empowers our team to deliver exceptional services nationwide. Benefits: Competitive salary with performance-based incentives, comprehensive health, dental, and vision insurance, plus 401(k) matching. Generous paid time off, remote work stipend for home office setup, and employee assistance programs. Access to professional development resources and flexible scheduling options. Growth Opportunities: Advance your career with pathways to senior claims analyst, supervisor roles, or specialized positions in utilization review. Ongoing training in evolving insurance regulations and coding updates, mentorship programs, and performance reviews with clear promotion tracks ensure your professional development at Lensa.