Claims Repricing Coordinator
Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.
The TPA Repricing Coordinator supports the claims and repricing team by reviewing medical claims, applying appropriate network discounts, and ensuring pricing accuracy in accordance with client contracts and plan guidelines. This is an entry-level role ideal for someone detail-oriented who is interested in healthcare administration and claims operations.
Primary Responsibilities
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Review and reprice medical claims using contracted provider network rates
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Apply appropriate discounts based on PPO, rental networks, and client agreements
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Validate billed charges against fee schedules and contract terms
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Identify pricing discrepancies and escalate issues when necessary
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Communicate with internal teams regarding claim status and pricing questions
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Maintain accurate documentation and notes within claims systems
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Meet productivity and accuracy standards
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Follow HIPAA and data privacy guidelines at all times
Qualifications
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High school diploma or equivalent required; associate’s degree or coursework in healthcare, business, or related field a plus
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No prior healthcare or claims experience required (training provided)
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Strong attention to detail and accuracy
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Basic computer skills and comfort using multiple systems
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Ability to interpret contracts and follow written guidelines
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Good organizational and time-management skills
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Professional written and verbal communication skills
Preferred (But Not Required)
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Exposure to medical billing, insurance, or claims processing
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Familiarity with CPT codes or medical terminology
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Experience working in an office or administrative environment
What We Offer
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Comprehensive training and onboarding
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Opportunities for growth within claims, repricing, or operations
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Supportive team environment
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Competitive entry-level pay and benefits package
Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.
Pay Transparency
$15—$17 USD
Benefits:
- Comprehensive medical, dental, vision, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
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Paid time off (PTO) and disability leave
- Employee Assistance Program (EAP)
Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.