- Extensive knowledge of medical terminology, ICD9, ICD10, and CPT codes.
- Extensive knowledge of Plan benefits, group insurance, and Medicare principals.
- Knowledge of Coordination of Benefits rules.
- Considerable knowledge of basic math.
- Ability to maintain production standards in a detail‐oriented, quality‐conscious service environment.
- Ability to work independently with minimal supervision.
- Strong analytical abilities.
- Good written and verbal communication skills
- Research and respond to scheduled reports and claim inquiries sent by Blue Card and Blue Cross representatives in a timely manner.
- Investigate and adjudicate complex claim requests and claims requiring special handling, such as adjustments and complaints in accordance with Plan guidelines, policy contract language and departmental processes and standards.
- Write letters to participants and providers requesting additional information when necessary.
- Follow‐up on pending claims.
- Work with Eligibility Department to resolve eligibility problems, add or delete dependents, address changes, etc.
- Act in accordance with all HIPAA Privacy and Security guidelines to ensure confidential handling of protected health information.
- Answer phone calls from participants and providers when necessary.
- Regular, predictable, and reliable attendance is required.
- Ability to accept direction and developmental guidance from supervisor.
- Ability to work effectively with individuals at all levels.
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Claims Examiner
3 weeks ago
MedPOINT Management Los Angeles, United StatesJob Description · Job Description Summary: · Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge of medical terminology necessary. S ...
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Claims Examiner
2 weeks ago
Total Medical Staffing Los Angeles, United StatesJob Description · Job DescriptionPosition Title – Claims Examiner - Workers Compensation · Address – Remote CA · Pay -- $40/HR · Start date – ASAP · Hours – 8a-5p · Required Skills & Education: · • 2+ years workers comp claims experience · • Bachelor's degree required · • P ...
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Claims Examiner
3 weeks ago
TotalMed Staffing Los Angeles, United States*Position Title * Claims Examiner - Workers Compensation · *Address * Remote CA · *Pay*: $45 - $48.57 · *Hours * Monday-Friday 8:00am-5:00pm · *Vaccine Requirement * not required · *Position Purpose:* · The Claims Examiner - Workers Compensation analyze complex or technical ...
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Claims Examiner
2 weeks ago
Total Medical Staffing Los Angeles, United StatesJob Description · Job DescriptionPosition Title – Claims Examiner - Workers Compensation · Address – Remote CA · Pay -- $40/HR · Start date – ASAP · Hours – 8a-5p · Required Skills & Education: · • 2+ years workers comp claims experience · • Bachelor's degree required · • P ...
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Claims Examiner
3 weeks ago
Total Medical Staffing Los Angeles, United StatesJob Description · Job DescriptionPosition Title – Claims Examiner - Workers Compensation · Address – Remote CA · Pay -- $40/HR · Start date – ASAP · Hours – 8a-5p · Required Skills & Education: · • 2+ years workers comp claims experience · • Bachelor's degree required · • P ...
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Claims Examiner I
16 hours ago
L.A. Care Health Plan Los Angeles, United StatesThe Claims Examiner is responsible for the accurate and timely processing of direct contract and delegated claims per regulatory and contractual guidelines, which includes: - Processing claims for all lines of business, including complex claims - Mon Claims, Examiner, Processing, ...
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Hospital Claims Examiner
3 weeks ago
MedPOINT Management Los Angeles, United StatesJob Description · Job DescriptionThe claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospital Client. Researches, reviews and contacts provider services for proble ...
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Claims Examiner
2 days ago
ManpowerGroup Los Angeles, United StatesOur client, Legal Industry is seeking a Claims Examiner to join their team. As a Legal Claims Examiner you will be part of the Restructuring services supporting Restructuring services department. The ideal candidate will have Research, Administration and Analytical skills which w ...
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Claims Examiner III
3 days ago
UCLA Health Los Angeles, United StatesTake on a key role within a world-class, award-winning health system. Contribute to the delivery of award-winning patient care. Take your career in an exciting new direction. You can do all this and more at UCLA Health. You will be responsible for ac Claims, Examiner, Patient Car ...
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Medical Claims Examiner
1 day ago
SCUFCW Trust Fund Los Angeles, United StatesJob Description · Job Description***This position is located in Cypress, CA · Southern California United Food & Commercial Workers Unions & Food Employers Joint Benefit Funds Administration, LLC (The Funds) were created more than 40 years ago as a result of collective bargaining ...
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Claims Examiner
3 weeks 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
3 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
2 weeks ago
TEKsystems Whittier, United States contract*Top Hospital Network is Hiring a Medical Claims Examiner * · *Title*: Claims Examiner · *Pay*: 22-25/hr · *Location*: Whittier, CA · *Duration:* 3 month Contract – Potential to be extend · * * · *Employee Value:,* · * Weekly Pay · * Benefits through TEKsystems · * Great oppor ...
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Claims Examiner
2 days ago
Experis Pasadena, United StatesJob Title: Workers Compensation Claims Examiner · $47.85hr · 5 Month contract with opportunity for extension · Must Have Requirements: · - Must Reside in CA. Can be hybrid or remote · - 6 years plus Experience · - College degree · - 6+ yrs workers' compensation claims experience. ...
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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 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 adjudication of Com ...
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Senior Claims Examiner
4 weeks ago
Carl Warren & Company Anaheim, United StatesCOMPANY OVERVIEW: · Carl Warren & Company is a leading nationwide Third-Party Administrator (TPA) founded in 1944. Carl Warren has been a trusted partner specializing in property and casualty claims management, subrogation recovery, and litigation management for private and publ ...
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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 Examiner
3 weeks 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 II
2 weeks ago
L.A. Care Health Plan Los Angeles, United StatesSalary Range: $55, Min.) - $69, Mid.) - $75, Max.) · Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated ...
Medical Claims Examiner - Los Angeles, United States - Insight Global
Description
Required Skills & Experience
Job Description
A Medical Health Insurance Plan based in Los Angeles is in the immediate need of a Medical Claims Representative. The Medical Claims Representative will be responsible for speaking with members over the phone and troubleshooting any of the participants bills or claims. The Medical Claims Representative will be tasked with answering inquiries regarding EOBs as well as any other issues pertaining to medical claims. Once the candidate is up and running, promotions will become available. The right person for this job will have a background in either medical claims, insurance verifications/authorizations or medical billing.
Compensation:
$20/hr to $22/hr.
Exact compensation may vary based on several factors, including skills, experience, and education.
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.