Springfield IL - Medical Insurance Specialist

Springfield IL - Medical Insurance Specialist

Hiring Department: Division of Specialized Care for Children

Location: Springfield, IL USA

Requisition ID: 1041847

FTE: 1

Work Schedule: M - F 8:00am - 4:30pm

Shift: Days

# of Positions: 1

Workplace Type: Hybrid

Posting Close Date: 8/2/2026

Salary Range (commensurate with experience): $40,891 - $47,101

About the University of Illinois Chicago

UIC is among the nation’s preeminent urban public research universities, a Carnegie RU/VH research institution, and the largest university in Chicago. UIC serves over 34,000 students, comprising one of the most diverse student bodies in the nation and is designated as a Minority Serving Institution (MSI), an Asian American and Native American Pacific Islander Serving Institution (AANAPSI) and a Hispanic Serving Institution (HSI). Through its 16 colleges, UIC produces nationally and internationally recognized multidisciplinary academic programs in concert with civic, corporate and community partners worldwide, including a full complement of health sciences colleges. By emphasizing cutting-edge and transformational research along with a commitment to the success of all students, UIC embodies the dynamic, vibrant and engaged urban university. Recent “Best Colleges” rankings published by U.S. News & World Report, found UIC climbed up in its rankings among top public schools in the nation and among all national universities. UIC has nearly 260,000 alumni, and is one of the largest employers in the city of Chicago.

This position is intended to be eligible for benefits. This includes Health, Dental, Vision, Life Insurance, a Retirement Plan, Paid time Off, and Tuition waivers for employees and dependents.

Position Summary
Review, analyze and enter medical claims, interpret third party payment information, coordinate benefit coverage information in order to determine DSCC financial liability.

Employees at this level are senior representatives under limited supervision who provide technical assistance and guidance to DSCC staff, providers and families on complex issues independent of manager oversight to facilitate medical claims processing.

Duties & Responsibilities

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• Analyze , process and adjust paper & electronic claims for accuracy. Reviews case specific information to enter the prior approval for claim adjudication.

• Resolve complex collections, provider and customer complaints independent of manager oversight.

• Train providers to use the Provider Portal application and provides instructions on procedures and policies for claims adjudication.

• Determines the policy provision for complex nursing and medical claims. Communicates findings with DSCC staff and providers. Determines a resolution to process the claim.

• Reviews and analyzes provider claims and insurance explanation of benefits for quality assurance. Initiates, receives and documents telephone calls to facilitate claims payment process. Serves as the primary point of contact for providers, DSCC staff and families in various situations.

• Determines appropriate adjustments needed when explanation of benefit’s, refund checks or claims are resubmitted by providers or families.

• Attends Division and university related meetings and serves as a departmental liaison in the absence of the manager.

• Trains new and lower level staff on unit policies and procedures, including processing of claims. Reports and training issues to claims manager.

• Identifies needs/problems with computer software programs and agency claims processing practices, makes recommendations for change or enhancement to manager.

• Conducts file audits to obtain reimbursement of DSCC expenditures due to benefit coverage changes, claims processed incorrectly by insurance carriers and discrepancies of insurance benefit coverage.

• Prepares reports or written correspondence for the manager as requested.

• Assists manager on revisions to the Home Care and Core Department Manual.

• May supervise lower level staff as assigned in the absence of the department manager.

• Conducts quarterly quality assurance audits on finalized claims based on departmental guidelines.

• Other duties as assigned.

Minimum Qualifications

To Apply: For fullest consideration click on the Apply Now button, please fully complete all sections of the online application including adding your full work history with specific details of your duties & responsibilities for each position held. Fully complete the education, licensure, certification and language sections. You may upload a resume, cover letter, certifications, licensures, transcripts and diplomas within the application.

Please note that once you have submitted your application you will not be able to make any changes. In order to revise your application you must withdraw and reapply. You will not be able to reapply after the posting close date. Please ensure the application is fully completed and all supporting documents have been uploaded before the posting close date. Illinois Residency is required within 180 days of employment.

The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify.

The university provides accommodations to applicants and employees. Request an Accommodation

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.