- The claims examiner reports directly to the claims manager.
- They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.
- High school graduate or equivalent required. Must have physical proof on hand if background check is unable to verify your education background.
- Minimum of 2 years claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environment
- Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
- Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims
- Knowledge of compliance issues as they relate to claims processing
- Experience in interpreting provider contract reimbursement terms desirable
- Ability to identify non-contracted providers for Letter of Agreement consideration
- Data entry experience
- Training on basic office automation and managed care computer systems
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Claims Examiner
1 hour ago
alphapro technology, a.p.r., inc. Whittier, United StatesOverview: · **Responsibilities**: · - Review and analyze insurance claims to determine their validity · - Investigate potentially fraudulent claims · - Utilize auto estimating software to assess damage and costs · - Negotiate settlements with claimants or their representatives · ...
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Medical Claims Examiner
2 weeks ago
The Principle Group Whittier, United States**Description**: · **JOB TITLE**: Claims Examiner - Days · **LOCATION**: 9557 Greenleaf Avenue, Whittier, CA · **SHIFT**: Monday - Friday - 07:00am - 03:30pm · **DURATION - 13 weeks(extend)** · ** 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER ED ...
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Claims Examiner
4 days ago
MemorialCare Medical Foundation Fountain Valley, United States**Claims Examiner** · - (MEM008006) · **Description** · **Title**: Claims Examiner · **Location**: Fountain Valley · **Department**: Claims · **Status**: Full-Time · **Shift**: Days (8hrs) · **Pay Range**:$21.37/hr - $30.97/hr · At MemorialCare Health System, we believe in provid ...
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Claims Examiner
1 week ago
E-Solutions Whittier, United StatesPOSITION SUMMARY: · The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for ...
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Claims Examiner
4 days ago
Innovative Management Systems Incorporated Whittier, United StatesJob Description · Job DescriptionDescription:The Position. · We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits based on established criteria and provider ...
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Claims Examiner
1 week ago
E-Solutions IT Services Private Limited Whittier, United States*MUST HAVE:* · *1. 2+ years of Claims ADJUDICATION experience | * · *2. 1+ years experience working as a claims examiner | * · *3. Experience in ambulatory, acute care hospital, HMO, or IPA environment | * · *4. 3+ years experience in a CoC-accredited site and are versed in Ca ...
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Claims Examiner
1 week ago
Innovative Management Systems Incorporated Whittier, United States: · The Position. · We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits based on established criteria and provider contracts. · Experience in adjudicatio ...
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Claims Examiner
1 week ago
Health Advocates Network, Inc. Whittier, United StatesHealth Advocates Network ishiring a Claims Examiner (2 Years Exp Req) This is a full-time contract position at a nationally recognized hospitallocated in Whittier, CA. · Pay Rate: $29.00/hour · Shift: Days (8hrs) · Start Date: ASAP · Contract Length: 13 weeks · Claims Exami ...
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Claims Examiner
2 weeks ago
Innovative Management Systems Incorporated Whittier, United States:The Position. · We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits based on established criteria and provider contracts. Experience in adjudication of Com ...
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Claims Examiner
2 weeks ago
TEKsystems Whittier, United StatesJob Description · Job DescriptionJoin a large hospital here in the Whittier Area · Job Description: · The claims examiner reports directly to the claims manager. · They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HC ...
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Claims Examiner
2 weeks ago
Innovative Management Systems Incorporated City of Industry, United States:The Position. · We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits based on established criteria and provider contracts. Experience in adjudication of Com ...
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Claims Examiner
1 week ago
Innovative Management Systems Incorporated City of Industry, United States:The Position. · We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits based on established criteria and provider contracts. Experience in adjudication of Com ...
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Claims Adjuster/claim Examiner
1 week ago
DB Insurance Anaheim, United StatesCompany and Position Overview · DB Insurance Co Ltd (US Branch) is looking for a full-time LIABILITY CLAIMS ADJUSTER/EXAMINER who has experience handling Commercial General Liability/Auto BI Liability claims. · **About DB Insurance** · DB Insurance Co., Ltd. Is one of the largest ...
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Claims Examiner
5 days ago
Managed Staffing Santa Fe Springs, United StatesJob Description · Job DescriptionJob Title: Claims Examiner · Location: 9557 Greenleaf Avenue, Whittier, CA · Shift: Monday - Friday, 07:00 am - 03:30 pm · Experience Requirement: Minimum of 2 years of adjudication-related experience in an ambulatory, acute care hospital, HMO, or ...
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Claims Examiner
1 week ago
Innovative Management Systems Incorporated Hacienda Heights, United States: The Position. · Do not wait to apply after reading this description a high application volume is expected for this opportunity. · We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate t ...
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Claims Examiner/ Claims Processor
1 week ago
Managed Staffing Whittier, United StatesJob Summary: · *We are seeking a skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for analyzing and processing insurance claims.* · * *PAY RATE: $29.00/hr. · --to--$32.00/hr. on w2* · *REQUIREMENTS:* · * *2 YEARS EXPERIENCE REQUIRED * ...
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Claims Examiner
5 days ago
North American Staffing Group Montebello, United StatesJob Description · Job DescriptionPosition Type: Direct HireLocation: Montebello, CA (Hybrid after initial training onsite is completed)Hourly Rate: $24 - 30/HR depending on years of experienceSchedules Available: 6AM - 3PM, 7AM - 4PM, 8AM - 5PM · Requirements:Minimum 2 - 3 years ...
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Claims Examiner Iii
1 week ago
TRISTAR RISK MANAGEMENT Signal Hill, United States**This position requires the employee to be bilingual English/ Spanish.** · ***:Under mínimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. · This position requires considerable interaction w ...
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Claims Examiner Iii
1 week ago
Advanced Medical Management, Inc. Long Beach, United States**Claims Examiner III** · **Role Insights** · **Primary Responsibilities** · - Audit claims processing quality, develops, maintains and runs standard reports · - Assist the Claims Supervisor/Director in reviewing the quality auditing tracking/reporting (financial and procedural) ...
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Claims Examiner
1 week ago
Innovative Management Systems Incorporated City of Industry, CA, United States: · The Position. We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits based on established criteria and provider contracts. Experience in adjudication of C ...
Claims Examiner - Whittier, CA, United States - TEKsystems
Description
Join a large hospital here in the Whittier Area
Job Description:
Main Details:
Start Date: Two weeks post offer date, once you have cleared the onboarding process
Pay: $24.00/Hr
Schedule: Monday - Friday 7:00am - 3:30pm
Location: Whittier, CA
Duration: 3 Month Contract. Possibility of extension based on business need
Qualifications:
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
