Assistant Claims Examiner

Are you someone who thrives on accuracy, empathy, and helping others navigate complex systems? We're seeking a dedicated Claims Processor to support the timely and precise handling of Medicaid and Medicare claims. In this role, you'll be responsible for reviewing and entering insurance claims, communicating with customers to clarify documentation, and verifying policyholder and beneficiary information. You'll play a key part in ensuring that claims are processed efficiently and correctly, helping individuals access the benefits they rely on. This position is ideal for someone who enjoys problem-solving, values confidentiality, and is comfortable working in a fast-paced, team-oriented office environment. If you're looking to build your career in healthcare claims and make a real difference in people's lives, we'd love to welcome you aboard.

WORKSITE: Irving, Texas

WORK SCHEDULE: On-site Monday-Friday, 8:00 AM to 4:00 PM. Remote hybrid 1-2 days

COMPENSATION: $17.00 Per Hour

WHAT WE OFFER:

• Paid sick leave based on state regulations after 90 days of employment
• Medical, dental, and vision are offered after a waiting period (60% paid by Fortuna)
• Free TeleMedicine and Mental Health for all employees and their families
• Additional volunteer options such as Group Life Insurance, Accidental Insurance, Critical Care, Short Term Disability

WHAT YOU'LL DO:

As an Assistant Claims Manager, you'll be responsible for managing the full lifecycle of Medicaid and Medicare claims, ensuring accuracy, timeliness, and compliance with regulatory standards. Your day-to-day responsibilities will include:

• Enter and review insurance claims submitted electronically or in written form, focusing on less complex or standard cases
• Answer incoming calls from claimants, providing updates, clarifying documentation needs, and resolving basic inquiries with professionalism and empathy
• Confirm policyholder details, coverage dates, premium status, and claim eligibility using internal systems and external sources
• Request and track updates or corrections to claim forms, ensuring all required information is complete and accurate
• Identify missing or incomplete data and proactively reach out to claimants, providers, or other relevant parties to obtain necessary documentation
• Assess straightforward claims for validity, determine payment amounts, and secure appropriate approvals before issuing payments
• Keep claimants informed of progress and resolution, escalating complex or sensitive issues to senior team members when needed
• Work closely with colleagues in a supportive office environment to meet processing deadlines and uphold service standards

WHAT YOU'LL BRING:

• Minimum of 2-3 years of experience as a paralegal or working with Medicaid/Medicare claims
  • Familiarity with healthcare benefits, insurance procedures, or legal documentation related to government programs
  • Strong attention to detail and ability to read and interpret fine print
  • Excellent research skills and sound judgment for making informed decisions
  • Comfortable switching between multiple systems and software platforms
  • Proficient in Microsoft Office tools (Outlook, Word, Excel) and web browsing
  • Fast and accurate data entry skills with a commitment to confidentiality
  • An organized and methodical approach to managing documentation and tasks
  • Strong communication skills for interacting with claimants and internal teams
  • Ability to work independently while contributing to a collaborative team environment

Fortuna operates as a staffing agency that sources, screens, and presents potential candidates for employment opportunities on behalf of our clients.

Fortuna was founded in 2012 by practicing professionals with more than 50 combined years of experience. Our headquarters is in McClellan, California with offices in Los Angeles and New York, and satellite offices in the Philippines and Israel. Fortuna is an active member of multiple California service agreements, including the CMAS, ITMSA (Tier 2), and CalPERS SpringFed Pool, as well as various municipalities and large corporation vendor pools

Career Site: www.gofortuna.com.