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Medical Billing / Claims Administrator
full-time•Wilmington•$0k - $0k
About this role
Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Ametros's team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients. Our flagship product is revolutionizing the way funds from insurance claim settlements are administered after settlement. Ametros continues to innovate, bringing new solutions to the market with the goal of simplifying healthcare for our clients. We make managing medical funds safe, effortless, and cost effective for everyone.
The Claims Specialist plays a critical role in the end-to-end management of member claims, ensuring accuracy, timeliness, and compliance across all claim-related activities. This position requires strong analytical skills, attention to detail, and the ability to collaborate across departments and with external partners to resolve complex issues and improve operational efficiency.The Claims Specialist plays a critical role in the end-to-end management of member claims, ensuring accuracy, timeliness, and compliance across all claim-related activities. This position requires strong analytical skills, attention to detail, and the ability to collaborate across departments and with external partners to resolve complex issues and improve operational efficiency.
What you will do
Assess claims to determine whether services are related to covered injuries and compliant with the guidelines of the member's settlements, ensuring appropriate benefit coordination.
Maintain comprehensive documentation of all claim-related communications, ensuring timely follow-up and resolution.
Proactively detect claim discrepancies, errors, or delays and collaborate with internal teams and providers to drive swift resolution.
Manage transitions for claims outside of CareGuard coverage, ensuring seamless member experience and accurate benefit coordination.
Handle inbound and outbound calls, emails, and chats related to claims, coverage guidelines, and provider inquiries providing expert-level support and guidance to a wide variety of audiences.
Oversee the bill payment process, including detailed review and validation of claims to ensure proper fund allocation and compliance.
Audit electronic claims feeds and bill review workflows to ensure data accuracy and operational integrity.
Partner with IT and Management to identify and resolve system-related issues impacting claims processing.
Coordinate with external vendors to resolve billing discrepancies and ensure alignment with contractual terms.
Act as a resource for Member Care and Pharmacy representatives, offering guidance and support on billing and claims procedures.
Identify opportunities for improvement within existing claims workflows and contribute to process enhancement initiatives.
Generate ad hoc reports in Excel to support management decision-making.
Lead or contribute to special projects and initiatives as assigned by Management, driving innovation and continuous improvement.
Conduct research and analysis to support the resolution of claims.
Skills and Abilities
Well versed with healthcare and medical terminology.
Excellent written and verbal communication skills with ability to adapt communication style depending on audience.
Understanding of Worker’s Compensation and Medicare coverage guidelines.
Meticulous attention to detail.
Highly organized and focused with the ability to prioritize and multitask.
Aptitude for problem-solving.
Sound business judgment and computer skills.
A desire to continue to learn and improve both self and the organization.
Ability to work both independently and collaboratively within a team environment.
Education Qualifications
H.S. Diploma or General Education Degree (GED) required
Bachelor’s Degree in Arts/Sciences (BA/BS) preferred
Experience Qualifications
3-4 years experience with ICD-10, CPT, NDC and HCPCS coding and procedures required
3-4 years Healthcare industry medical billing experience strongly preferred
This is a Hybrid role with a 3 day a week in office requirement
The estimated salary range for this position is $26.00-$28.00 per hour, 40 hours per week. Actual salary may vary up or down depending on job-related factors which may include knowledge, skills, experience, and location. In addition, this position is eligible for incentive compensation.
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Webster Financial Corporation and its subsidiaries (“Webster”) are equal opportunity employers that are committed to sustaining an inclusive environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, national origin, ancestry, citizenship, sex, sexual orientation, gender identity and/or expression, physical or mental disability, protected veteran status, or any other characteristic protected by law.
What you'll do
- The Claims Specialist is responsible for the end-to-end management of member claims, ensuring accuracy, timeliness, and compliance. This includes assessing claims, maintaining documentation, resolving discrepancies, and overseeing the bill payment process.
About Ametros
Ametros, the industry leader in professional administration, transforms how injured individuals manage their healthcare after a settlement. We empower people with the tools, support, and guidance they need to make smart, confident decisions about their medical funds.
CareGuard, our professional administration service, simplifies the administration of Medicare Set Asides (MSAs) and other future medical allocations, facilitating compliance and peace of mind. We work closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to deliver a seamless, supportive experience.
As a division of Webster Bank, N.A. (NYSE: WBS), a leading commercial bank headquartered in Stamford, CT, Ametros continues to innovate, bringing forward-thinking solutions to the market that make managing medical funds safe, effortless, and cost-effective.
Ametros is an equal opportunity employer that is committed to sustaining an inclusive environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, national origin, ancestry, citizenship, sex, sexual orientation, gender identity and/or expression, physical or mental disability, protected veteran status, or any other characteristic protected by law.
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Frequently Asked Questions
What does Ametros pay for a Medical Billing / Claims Administrator?
Ametros offers a competitive compensation package for the Medical Billing / Claims Administrator role. The salary range is USD 0k - 0k per year. Apply through Clera to learn more about the full compensation details.
What does a Medical Billing / Claims Administrator do at Ametros?
As a Medical Billing / Claims Administrator at Ametros, you will: the Claims Specialist is responsible for the end-to-end management of member claims, ensuring accuracy, timeliness, and compliance. This includes assessing claims, maintaining documentation, resolving discrepancies, and overseeing the bill payment process..
Is the Medical Billing / Claims Administrator position at Ametros remote?
The Medical Billing / Claims Administrator position at Ametros is based in Wilmington, Massachusetts, United States. Contact the company through Clera for specific work arrangement details.
How do I apply for the Medical Billing / Claims Administrator position at Ametros?
You can apply for the Medical Billing / Claims Administrator position at Ametrosdirectly through Clera. Click the "Apply Now" button above to start your application. Clera's AI-powered platform will help match your profile with this opportunity and guide you through the application process.