- Full-Time.
- Benefits Eligible: Medical, Dental, Vision, Paid Time off, and more.
- Non-exempt.
- Monday - Friday.
- Work-Life Balance.
- Identifying authorizations and matching authorization to claims.
- Troubleshooting and/or answering claims questions to internal/external stakeholders.
- Adjudicating claims in the correct financial banks.
- Identifying dual coverage and potential third-party liability claims.
- Coordination of Benefits to management for approval and updating system insurance coverage profile.
- Understanding and interpreting health plan Division of Financial Responsibilities and contract verbiage.
- Supporting the Claims Departments and other Examiners and troubleshoots Claims issues for internal/external stakeholders.
- Documenting resolution of claims to support claim payment and/or decisions.
- High School Diploma and/or equivalent work experience in managed care/services, health plan, and/or IPA.
- Minimum of 1 year of related claims processing experience in managed care/services, health plan, and/or IPA (preferred).
- Knowledge of HCFA 1500 forms, CPT, and ICD codes (required).
- Strong understanding of division of financial responsibility for determination of financial risk.
- Practical knowledge and understanding of relevant business practices and applicable regulations/policies.
- Excellent written and verbal communication.
- Strong contract verbiage and knowledge of claims processing software.
- Able to sit for long periods of time.
- Professional behavior, good business judgement and strong team interaction skills.
- Valid Driver's License or able to reliably commute to the office.
- U.S. Work Authorization (required.)
-
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 ...
-
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 ...
-
Claims Examiner
2 weeks ago
TEKsystems Whittier, CA, United StatesJoin 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 HCFA-1500 claims that are received ...
-
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 ...
-
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 ...
-
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 ...
-
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 ...
-
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 ...
-
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 ...
-
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 ...
-
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 ...
-
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 ...
-
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 ...
-
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 ...
-
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 * ...
-
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 ...
-
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 ...
-
Claims Examiner Iii
6 days 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) ...
-
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 Ii
20 hours ago
MemorialCare Medical Foundation Fountain Valley, United States**Claims Examiner II** · - (MEM008020) · **Description** · **Title**: Claims Examiner II · **Location**: Fountain Valley · **Department**: Claims · **Status**: Full-Time · **Shift**: Days (8hrs) · **Pay Range**:$22.41/hr - $32.50/hr · At MemorialCare Health System, we believe in ...
Claims Examiner - Whittier, United States - Innovative Management Systems Incorporated
Description
: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 Commercial, Medicare Advantage, and Medi-Cal claims will make you a great candidate, along with experience or familiarity with Healthcare Service industry, Independent Physician Associates (IPAs), and/or have experience in a Managed Care/Service Organization (MSO) or Health Plan background.
The Specs.
The Duties.
*Please note that the duties and responsibilities outlined above are summarized and may not encompass all tasks associated with the position. The nature of the role may require adaptation to changing circumstances and additional responsibilities not explicitly mentioned here. The organization reserves the right to modify, interpret, or supplement the job duties as needed.
THE COMPANY.
Innovative Management Systems is a management services company focused on finding innovative ways to ensure regulatory compliance, customer services, provider experience, and measurable outcomes in the healthcare industry. Through our ever-evolving data analytics platform, we strive to improve overall medical spending, HEDIS, and STAR measures through a collaborative effort of education, reporting and workflow management. Come be part of the team that helps to improve quality of care, reduce administrative burden, and achieve greatness through creative thinking and educated calculated risks. Be the change in healthcare everyone talks about, but few people achieve. We value our team's opinions and new ways of getting the job done and are looking for self-starters with fresh ideas, ready to help pave the way to a better tomorrow.
We are an Equal Opportunity Employer and seek diversity in our workforce. We are also an E-Verify Employer, you can learn more about E-Verify program and your rights and responsibilities here: Learn More About E-Verify.
Requirements:What You Need.
Compensation details: 20-24 Hourly Wage
PI9f4ab98be
