Exception Processing Specialist- Medical Benefits

Company Overview

ASR Health Benefits, based in Grand Rapids, MI, is a fast-growing third-party administrator of health plans, including medical, dental, vision, short-term disability, Section 125 plans, and consumer-directed health plans. We administer these health plans through dedicated client service teams, consisting of staff members from each department at ASR who work together to meet our clients’ needs.

Position Summary

The Exception Processing Specialist is responsible for reviewing, researching, and resolving claim refunds.  This role requires an understanding of medical benefits, plan documents, and regulatory requirements to ensure accurate claim resolution, compliance, and excellent service to providers and internal stakeholders.

Essential Duties and Responsibilities:

• Review and process claim refunds received from providers
• Collaborate with Claims Analysts, Supervisors, and other departments to resolve escalated claims issues
• Apply clinical, contractual, and benefit logic to ensure accurate communication
• Document findings, decisions, and resolutions clearly and thoroughly in the claims system
• Respond to internal and external inquiries in a professional and timely manner
• Assist in identifying trends, root causes, and opportunities for process improvement
• Ensure compliance with HIPAA, ERISA, and other applicable federal and state regulations
• Maintain productivity and quality standards while handling sensitive or complex cases
• Assist with provider overpayment follow-up process
• Assist Finance Department with Accounts Receivable
• Other duties as assigned

Knowledge, Skills, and Abilities:

• Strong understanding of medical insurance benefits and claims adjudication processes
• Ability to interpret plan documents, policies, and contractual language
• Excellent analytical, problem-solving, and decision-making skills
• High attention to detail and accuracy
• Effective written and verbal communication skills
• Ability to work independently and manage multiple priorities
• Proficiency with claims processing systems and standard office software
• Professional judgment when handling sensitive or non-routine claim scenarios

Education and Experience:

• High school diploma or equivalent required; associate’s or bachelor’s degree preferred
• Minimum of 2–4 years of experience in medical claims processing or medical billing
• Experience handling complex or escalated claims strongly preferred
• Knowledge of CPT, ICD-10, and HCPCS coding preferred

Work Environment & Physical Requirements:

• In Office position
• Prolonged periods of sitting and computer use
• Ability to maintain focus on detailed work for extended periods

Core Competencies:

• Accountability
• Confidentiality
• Critical Thinking
• Customer Focus
• Compliance Awareness
• Collaboration

Disclaimer

This job description is not intended to be an exhaustive list of duties, responsibilities, or qualifications. Management reserves the right to modify, add, or remove duties as business needs require.

Please visit www.asrhealthbenefits.com and navigate to the CAREERS link on the homepage to view ASR’s current openings.

ASR is an equal opportunity employer committed to creating an inclusive environment for all employees. 

No agencies please.