Claims Processor

Position Title:          Claims Processor 

Location:                Circle of Health

Reports to:              Circle of Health Benefits Manager

Grade Level:            $13.16 - $24.84

Opening Date:         April 30, 2026

Closing Date:           Until Filled 

*** Any individual who receives an offer of employment or will receive a payroll check are required to submit to a drug and alcohol test as a condition of obtaining employment.*** 

            ****Mille Lacs Band Member/American Indian preference applies****

SUMMARY:

Circle of Health was developed to assist with premiums, co-pays and deductibles for the Mille Lacs Band of Ojibwe band members and their prospective families.  This position processes claims and reimbursements.

QUALIFICATIONS:

• Two years of post-secondary education is preferred
• Three years’ experience health insurance billing or claims experience.
• Knowledge of Medicare, Medicaid, and private insurance eligibility requirements.
• Basic computing skills in a Windows environment, including Word and spreadsheet software.
• Ability to work and communicate sensitively, confidentially, and effectively with band members, families, public agencies and co-workers.
• Very strong written and verbal communication skills.
• Knowledge of Data Privacy Act and ability to maintain strict confidentiality of band member, provider, and band information.
• Experience in and sensitivity to Native American culture.
• Ability to understand and follow directions.
• Must pass a background check.
• Must pass a pre-employment drug and alcohol test.

DUTIES AND RESPONSIBILITIES:

• Processes claims in a timely manner.
• Follows HIPAA regulations.
• Ensures that band members are using the correct and chronological avenues in acquiring insurance coverage, then directs them to the Benefit Coordinator.
• Assist band members with Medicare, Medicaid and other services.
• Assists with Office & File support when needed.
• Assists with band mailings.
• Creates denial letters and maintains correspondence on the ACT system.
• Maintains monthly log of denials, to present to Benefit Manager and Commissioner of Health and Human Services.
• In the absence of another Claims Processor/Benefit Coordinator will assist with band member inquiries to the best of their ability.
• In the absence of another Claims Processor/Benefit Coordinator will process reimbursement claims.
• Performs other duties as deemed appropriate by Circle of Health Benefit Manager.

WORKING CONDITIONS:

• Nature of work is such that incumbent experiences infrequent periods of moderate stress levels while dealing with band members, families, and others.
• Work is exclusively in doors in a controlled climate area.
• Little threat of personal danger or risk.
• Hours are typically 8-5, but possibly with some extra hours.  May involve some evening or weekend work.