Medical Claims Associate

Position Summary

As a Medical Claims Associate, you will be a primary point of contact for members, providing timely, accurate, and compassionate phone support. You will answer questions about benefits, claims, and financial matters; explain coverage; guide members through the claims process; and help resolve concerns. By combining strong customer service skills with insurance and claims expertise, you will contribute to a positive member experience and efficient claims operations.

Key Responsibilities

• Manage a steady volume of member calls while delivering accurate, efficient, and high-quality service.
• Explain medical, vision, financial, and other benefit programs to help members understand their coverage and available resources.
• Assist members with questions regarding claims, Explanation of Benefits (EOBs), eligibility, deductibles, copayments, and payment information.
• Research and resolve member concerns, escalating complex claim issues when appropriate.
• Accurately document calls, complete follow-up activities, and maintain detailed records in accordance with departmental procedures.

Requirements & Tech Stack

• Medical Terminology Certification required, or the ability to obtain certification within 6-months of completing claims training.
• Inbound and outbound telephone customer service experience.
• Knowledge of medical insurance plans and healthcare benefits.
• Strong interpersonal skills and member service orientation.
• Excellent customer service and communication skills.
• Ability to manage multiple priorities with attention to detail.
• Proficiency with Microsoft Office applications.
• Ability to report to the office when required.

Qualifications

Education:

• Required: High school diploma or GED
• Preferred: Associate degree

Experience:

• Up to 12 months experience in claims processing working with medical insurance plans OR 12 months in a healthcare billing office.

Work Environment:

• Hybrid Schedule: Eligible for NRECA’s hybrid schedule (up to 2 days/week remote).
• Work Hours: Monday – Friday, 8:15 a.m. – 5:00 p.m.
• Location: Lincoln, NE

Physical Requirements:

• Primarily sedentary work with extended periods of sitting.
• Visual acuity sufficient for computer work and data analysis.
• Manual dexterity for frequent keyboard use.
• Occasional light lifting (up to 10 lbs).
• Effective communication in person, by phone, and via email.