Group Management Services is looking for self motivated individual to step into our Claims Examiner II role based out of our Richfield, OH headquarters.

As with all positions here at GMS, we are looking for a driven individual with a customer service oriented mindset and a passion for helping others.  If expanding your professional human resources career is your goal than this opportunity may be just what you are looking for!

What are some expectations for this role?

• Examine, process and adjudicate claims for medical, dental and prescriptions.
• Identify claims to be processed in order of identified importance and work within time limitations.
• Resolve issues and identify customer needs (call on issues if missing information or additional info needed).
• Assists Sr Claims with audit/internal controls
• Answer calls and correspondence (emails) from members, clients and providers.
• Verify correct plan loading (making sure claim is processed according to the client’s plan).
• Follow up with pended claims.
• Maintain daily paid claims workload
• Investigate all code review output for a claim and correctly processes according to set procedures.
• Pull pended claims over 30 days old and processes accordingly
• Investigate and resolve outstanding issues on behalf of the member by communicating with applicable departments and responding to the member
• Initiate claim adjustments, additional ID card replacements, duplicate EOB’s, canceled check requests, etc.
• Attend vendor meetings/calls/webinars
• Perform all other duties as assigned

What are the qualifications for this role?

• High School diploma (or GED or High School Equivalence Certificate) required Bachelor's degree preferred; minimum of 3 years related medical claims adjudication experience required. 
• Knowledge of CPT & Diagnosis Codes; knowledge of coordinating benefits with primary carriers

Whats in it for you?

• Base Salary Range between $58,000-$68,000
• Full Medical, Dental, Vision, 401(k) with company match, Life, and Disability benefits package
• Tuition Assistance
• Three weeks of PTO with 7 paid holidays
• Company Surface Pro or Laptop provided
• Monthly cell phone reimbursement plan
• Opportunities for growth
• Flexible scheduling and autonomy 

Why GMS?

People don't necessarily buy what you do, they buy WHY you do it.  GMS is passionate about small businesses having started off as one back in 1996 in Richfield, OH with only a few employees.  Fast forward to today and we have over 500 employees in 24 offices across 18 states nationwide.  We take pride in building and maintaining quality relationships with our customers as we help them grow their own business exponentially just as we did by allowing them the time and energy to focus solely on reinvesting in themselves.

As we continue to expand ourselves here at GMS, we are looking for individuals who are willing and able to provide excellent customer service and support to their clients.  We are looking for those who are passionate about the value small business brings and providing them assistance in their growth as they seek growth for themselves.  We are committed to providing opportunities for upward mobility from within to those who are driven to succeed and who care about the relationships they build.  Join the GMS team today, build relationships, seek growth and experience a truly family oriented workplace culture!


For more information please visit our website at www.groupmgmt.com #LI-ONSITE

GMS is an Equal Opportunity Employer