Claims Examiner

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, HPI is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you.

What we do

HPI is unique. A respected industry leader that’s been serving customers for over 44 years, we’re known for our innovation and adaptability. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you’ll contribute to ideas that make a real difference for employers and employees nationwide. There isn’t a challenge we won’t accept and we’re looking for people who have a passion to take it on. Not just a job—a mission.

Our commitment extends beyond our clients to our own employees. We foster a supportive and inclusive work environment where innovation thrives. By investing in our team’s growth and well-being, we ensure they are equipped to provide exceptional service. 

What you’ll do

The Claim Examiner is responsible for the processing of medical claims in accordance with applicable plan benefits. The examiner is responsible for the handling of a specific block of group plans and is integral in maintaining the client/customer relationship with those group plans. The Claim Examiner will assist claimants, providers and/or clients with problems or questions regarding their claim and/or policies. All Claim Examiners are required to successfully complete a training session as approved by the Claims Manager.

In this role, you’ll also: 

• Process claims in accordance with plan benefits.
• Maintain minimum quality and production levels as determined by the Claims Manager.
• Maintain updated filings for claim benefit investigation (medical necessity reviews, etc.) as required in accordance with plan benefits.
• Prepare filings for outside vendors (subrogation) as required in accordance with the plan benefits.
• Handle correspondence from Plan Correspondent and/or employees in a timely and efficient manner.
• Resolve claim issues that do not require outside involvement.
• Serve as back-up to Customer Service department, as needed.
• Perform other various tasks that are deemed necessary and equitable by the Claims Manager

What you bring

• Ability to coordinate with management as effectively as with subordinates
• Ability to prioritize and multi task effectively
• Communicates effectively, both verbally and in writing
• Ability to work both independently and as a member of the team
• Ability to anticipate and understand systems interactions
• Must be detailed, analytical and accurate
• Recognize the need for follow-thru and follow-up 
• Ability to work within specified timeframe and meet deadlines
• Recognize and maintain confidentiality of work materials as appropriate
• High School diploma or combination of education, related experience or training
• Prior claim processing experience desired
• Knowledge of medical terminology and/or billing & coding preferred
• Proficient with Microsoft Word and Excel or similar PC based programs

Bonus points if you have experience working in the healthcare industry!

Why choose us?

• We’re a people-first company and value giving back to our community. Ask us about our volunteer opportunities.
• Our space is a reflection of who we are—innovative, open and collaborative.
• We think feeling your best is an important factor in producing great work, so we embrace a “smart casual” dress code and work at ergonomic desks. 
• Need to reenergize? When at our Westborough headquarters, take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms. 

Our Benefits Package

We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you! We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life, including:

• Medical, Dental and Vision and Prescription Drug Coverage
• Fitness Reimbursement Benefit
• Employee Assistance Program
• Flexible Spending Account & Health Savings Account
• 401(k) and Quarterly Bonuses
• Generous Paid-Time Off & Volunteering Opportunities
• Educational Assistance & Professional Development Opportunities

So, think you want to join the HPI team? We hope to hear from you!

You can read more about us at hpitpa.com/about-us/careers/

EEO/AA/M/F/Vet/Disability Employer