Top 111 Claims processing Jobs in O'fallon, Il

Group Accounts Representative
Delta Dental of Missouri —St. Louis, MO
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
Quick Apply
4d
Associate Specialist, Patient Access
Ensemble RCM LLC —O'Fallon, IL
- $17.00 - $18.15 an hour
- Full-time
- Hospital
- Customer service
- High school diploma or GED
- Tuition reimbursement
Pharmacy Tech Support / Call Center Rep (Remote Work from Home)
IQVIA —St. Louis, MO
- $18 an hour
- Full-time
- Remote
- Spanish
- English
- High school diploma or GED
- Work from home
10d
Patient Account Lead
BJC HealthCare —St. Louis, MO
- $18.85 - $31.30 an hour
- Full-time
- Mid-level
- Office
- High school diploma or GED
- Disability insurance
- Health insurance
Customer Service Representative
Koetting Insurance and Resource Agency LLC —Germantown, IL
- $18 - $22 an hour
- Full-time
- Microsoft Excel
- In-person
- Communication skills
- Dental insurance
- Vision insurance
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7d
Collection Specialist
St Louis Community Credit Union —Richmond Heights, MO
- $38,000 - $44,000 a year
- Online Application
- Background check
- Microsoft Excel
- Microsoft Outlook
- Disability insurance
- Health insurance
Quick Apply
Warranty Service Clerk
The Larson Group —Sauget, IL
- $15 - $30 an hour
- Microsoft Outlook
- Computer literacy
- Mid-level
- Paid holidays
- Health insurance
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2d
Senior Test Automation Engineer
Enterprise Mobility —St. Louis, MO
- Full-time
- Remote
- Computer Science
- Bachelor's degree
- Continuous improvement
- Profit sharing
- Health insurance
10d
Patient Financial Services Representative
Lifepoint Health —St. Louis, MO
- Full-time
- HIPAA
- Mid-level
- High school diploma or GED
- Disability insurance
- Health insurance
Quick Apply
Epic Denials Management Operator
Deloitte —St. Louis, MO
- $70,000 - $90,000 a year
- Full-time
- Microsoft Excel
- Mid-level
- Bachelor's degree
Pre-Certification Coordinator II - Pediatric Endocrinology
Washington University in St. Louis —St. Louis, MO
- $23.63 - $35.49 an hour
- Online Application
- Pass drug screening
- HIPAA
- Office
- Commuter assistance
- Health insurance
Epic Denials Management Coordinator
Deloitte —St. Louis, MO
- $50,000 - $60,000 a year
- Full-time
- Microsoft Excel
- Mid-level
- Bachelor's degree
HR & Talent Operations Specialist
Saint Louis Art Museum —St. Louis, MO
- $29.81 - $36.52 an hour
- Full-time
- Mid-level
- Office
- Bachelor's degree
- Wellness program
- Health savings account
7d
Product Management Senior Manager - Enterprise Gateway - Cigna Healthcare - Remote
The Cigna Group —St. Louis, MO
- $131,400 - $219,000 a year
- Online Application
- 7 years
- Analysis skills
- Bachelor's degree
- Paid holidays
- Health insurance
7d
Collections Manager
Neighbors Credit Union —St. Louis, MO
- $32.60 - $40.75 an hour
- Full-time
- 5 years
- Office
- Senior level
- Paid parental leave
- Disability insurance
Quick Apply
Mortgage Clerk
Cortex Consultants LLC —St. Louis, MO
- $20 - $30 an hour
- Contract
- Research
- Mid-level
- Office
- AD&D insurance
- Paid holidays
Quick Apply
8d
Patient Accounts Manager
BJC HealthCare —St. Louis, MO
- $69,326.40 - $112,860.80 a year
- Full-time
- Hybrid work
- High school diploma or GED
- Bachelor's degree
- Children
- Disability insurance
- Health insurance
11h
HR Generalist
CareVet —Clayton, MO
- Mid-level
- Administrative experience
- Analysis skills
Quick Apply
Operations and Sales Support Specialist - Des Peres area (St. Louis, MO)
Solventum —St. Louis, MO
- $24 - $26 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Driver's License
- Health savings account
- Disability insurance
Revenue Cycle Billing Rep
Chestnut Health Systems —Wood River, IL
- $17 - $18 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply

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Group Accounts Representative

Delta Dental of Missouri -
St. Louis, MO

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Job Details

4 days ago

Qualifications

Computer operation
Microsoft Excel
Microsoft Outlook
Computer literacy
High school diploma or GED

Full Job Description

We’re hiring a Group Accounts Representative to manage group setup, eligibility, billing, and ID card distribution. This client-facing role ensures accurate account data and smooth onboarding through electronic file troubleshooting. You’ll also monitor account balances, resolve payment issues, and support financial accuracy. If you’re detail-oriented and experienced in health benefits operations, we’d love to hear from you. Apply now to join a collaborative team in a hybrid work environment.

Position Summary:

The Group Accounts Representative is responsible for the accurate setup, maintenance, and ongoing administration of group accounts within the system, including eligibility, rating, billing configuration, and web access. This role ensures a seamless onboarding experience by troubleshooting and resolving issues related to initial electronic data files and system setup.

This position plays a critical role in maintaining financial accuracy by monitoring and reconciling client account balances, ensuring billing integrity, and supporting consistent revenue cycle performance. As a client-facing representative, this role serves as a key point of contact for resolving eligibility, billing, and payment-related inquiries, delivering timely, professional, and solution-oriented service.

Essential Functions and Job Responsibilities:

1. Establishes and maintains groups information including the setup for eligibility, rates, billing standards and web access. This work may include but is not limited to:

Loading and maintaining accurate eligibility and premium rates into the administration system.

Ensuring accuracy for rate setup and billing standards.

Determining the appropriate system changes needed to script for policies.

Testing group setup and ensuring the accuracy of systems based on policy requirements.

Setting up COB, dual Delta and member merge eligibility for appropriate claims payments.

Validating, assigning, and managing client user web access for processing eligibility, billing and retrieving premium billing invoices.

Notifying EDI team to load initial eligibility and validate for the ID card process.

Terminating eligibility and billing processes including reconciliation for final billing.

2. Troubleshoots issues with electronic eligibility files. This work may include but is not limited to:

Collaborating with the EDI team to address issues with electronic eligibility files.

Reviewing error reports and contacting clients for missing information to complete enrollment processing.

Identifying file issues and recommending solutions to clients.

3. Supplies groups with timely and accurate ID cards. This work includes but is not limited to:

Monitoring the production and distribution process for ID cards on all accounts.

Researching questions or issues related to ID cards.

Ensuring accurate and on-time delivery of all ID cards within a group.

Coordinating with the Group Accounts Supervisor on custom ID cards.

4. Communicates with clients regarding account balances, ID cards, eligibility questions and other file issues. This work may include but is not limited to:

Providing professional and consistent updates on the receipt of electronic eligibility files and the setup of account eligibility and ID cards.

Contacting clients to provide responses to questions and solutions to issues related to eligibility, web access or billing.

Collaborating with Account Managers to ensure strong communication for shared accounts.

Responding to calls and emails within a timely manner to ensure a positive client experience.

5. Monitors and reconciles account balances to ensure accuracy and payment on accounts. This work may include but is not limited to:

Monitoring receivable balances to ensure timely payments and research disputed or unreconciled account balances.

Addressing account balance issues with clients to ensure resolution.

Drafting delinquency letters and monitoring collection proceeding on balances.

Suspending accounts or initiating cancellation requests due to non-payment, in accordance with company guidelines, to ensure claim payments are placed on hold until the account is resolved.

Validating that self-billed client payments fall within the established exception thresholds, processing necessary adjustments and true-up billing to ensure account accuracy.

Reporting payment discrepancies to the Finance department for corrections.

Qualifications:

High School diploma or equivalent required.

Minimum of 3 years’ experience in the health benefits arena, preferably in operations, receivables, or reconciliation processes.

Proficiency in Microsoft Word, Excel, and Outlook.

Advanced problem-solving and decision-making abilities.

Exceptional verbal and written communication skills.

Ability to collaborate effectively with customers, colleagues, and leadership at all levels.

Competencies:

Accountability

Coachability

Collaboration

Communication

Critical Thinking

Organizational skills

Quality focused

Service orientation

Environment:

This position functions as a hybrid role working from both home and in-office environments. Any home office setting must be conducive to all guidelines outlined by the organization. This role is required to attend in-person meetings, the frequency of which is determined by management based on departmental or organizational needs.

Physical Demands:

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.

Specific vision abilities required by this job include the ability to adjust focus. While performing the duties of this job, the employee is regularly required to sit, talk, and hear. The employee is frequently required to use hands and arms to handle, feel, reach, and operate a computer.

Disclaimer:

This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required. The organization reserves the right to modify this job description at any time; including assigning or reassigning job duties.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

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Refine Your Search

claims processing jobs in o'fallon, il

Group Accounts Representative

Associate Specialist, Patient Access

Pharmacy Tech Support / Call Center Rep (Remote Work from Home)

Patient Account Lead

Customer Service Representative

Collection Specialist

Warranty Service Clerk

Senior Test Automation Engineer

Patient Financial Services Representative

Epic Denials Management Operator

Pre-Certification Coordinator II - Pediatric Endocrinology

Epic Denials Management Coordinator

HR & Talent Operations Specialist

Product Management Senior Manager - Enterprise Gateway - Cigna Healthcare - Remote

Collections Manager

Mortgage Clerk

Patient Accounts Manager

HR Generalist

Operations and Sales Support Specialist - Des Peres area (St. Louis, MO)

Revenue Cycle Billing Rep

I want to receive the latest job alert for claims processing in o'fallon, il

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