Medical Claims Processor

Join the DATAMARK, Inc. Team as a Medical Claims Processor! Are you looking for an exciting opportunity where your attention to detail and problem-solving skills make a real impact? Do you thrive in an environment that requires critical thinking and strong judgment? If so, we have the perfect role for you! As a Medical Claims Processor at DATAMARK, you'll play a vital role in the success of our operations by ensuring accurate and efficient back-office support. We are seeking a detail-oriented and performance-driven Medical Claims Processor to support patients prescribed complex and high-cost drug therapies. In this role, you will be responsible for verifying insurance coverage, conducting research, and resolving coverage-related issues to ensure timely and accurate prescription processing. This is a back-office position that requires strong analytical skills, efficiency, and comfort with outbound calls to insurance providers and patients. - Verify insurance coverage for new and existing patients to support timely prescription fulfillment - Pull and review customer accounts to assess eligibility, benefits, and coverage limitations - Conduct detailed research across multiple systems and portals - Initiate and complete outbound calls (OB calls) to insurance companies, pharmacies, and other partners to resolve coverage issues - Accurately document findings, decisions, and next steps in internal systems - Meet or exceed productivity expectations while maintaining accuracy - Identify and escalate complex cases or discrepancies as appropriate - Support patients requiring specialty, high-cost, or complex therapies through thorough and timely insurance determination Requirements - Previous experience in insurance verification, benefits investigation, pharmacy operations, or healthcare administration preferred - Knowledge of medical insurance terminology (deductibles, copays, prior authorizations, etc.) - Excellent reading comprehension and research abilities - Comfortable making outbound calls to resolve insurance or coverage-related issues - Strong problem-solving and critical-thinking skills - Ability to manage productivity metrics in a fast-paced environment - Basic computer proficiency and experience navigating multiple systems Benefits - Health Care Plan (Medical, Dental & Vision) - Retirement Plan (401k, IRA) - Life Insurance (Basic, Voluntary & AD&D) - Paid Time Off - Sign-on Retention Bonus: $500 after completion of training/OJT/Nesting, 1 week of production, and adhering to attendance policy. - Production Incentive: Additional pay per hour based on productivity goals and expectations. - WAH / Remote possible after Classroom Training/OJT/Nesting based on performance - Short Term & Long Term Disability - Training & Development - Wellness Resources - $16.50 per hour