- Accurately review all incoming Provider claims to ensure availability of necessary information.
- Achieve production standards for Hospital and IPA claims as set by claims management.
- Support other IPAs when necessary.
- Enter claims data accurately into the computerized adjudication system.
- Keep comprehensive documentation of processed claims and pending claims.
- Adjudicate claims following departmental policies, procedures, and relevant specialty claims regulations.
- Maintain production standards defined by claims management.
- Collaborate on resolving claims issues with other Departments or Payers.
- Assist Providers, Members, and other Departments in claims investigation.
- Serve as backup for other examiners in the Department.
- Contribute to the training of new claims staff.
- Foster a cooperative environment among all personnel.
- Participate in organizational meetings as needed.
- Adhere to organizational policies and procedures.
- Handle Customer Care inquiries.
- Perform additional tasks as assigned by supervisor/manager.
- Preferred experience in a managed care setting.
- Knowledge of ICD-9, ICD-10, and CPT-4 coding preferred.
- Detail-oriented with the capacity to work independently.
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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
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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
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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
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Diversified Technologies Inc. (DTI) Whittier, United StatesJob Location:9557 Greenleaf Avenue · - Whittier, CA 90601 · - Description: · - JOB TITLE: Claims Examiner - Days · - No interviews for this role. Offers based upon resume experience. · - LOCATION: 9557 Greenleaf Avenue, Whittier, CASHIFT: Monday - Friday - 07:00am - 03:30pm** 2 Y ...
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Claims Examiner
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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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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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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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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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Hospital Claims Examiner
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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 ...
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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 ...
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Insight Global Los Angeles, United StatesRequired Skills & Experience · 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. · Abilit ...
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Claims Examiner
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AltaMed Montebello, United StatesWork Boldly. Live Brilliantly. · At AltaMed, we don't just serve our communities, we are part of them. We have raised the expectations of what a community clinic can deliver because we think quality care is for everyone. And, we are determined to provide it no matter the challen ...
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Claims Examiner
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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 - Los Angeles, United States - MedPOINT Management
Description
Job Description
Summary:
Accurately handle, process and assess provider specialty claims, such as UB04s, following external regulations, internal standards, and contractual commitments. Understanding of medical terminology is crucial. Profound knowledge of Commercial, Medicare, and Medi-Cal codes. Basic computer skills required for research and review.
Duties and Responsibilities:
Minimum Job Requirements:
High school diploma or equivalent. One year of experience as a Claims Examiner using an automated adjudication system. Strong organizational and mathematical abilities. Proficiency in generating claims status reports and check runs.
Knowledge, Skills, and Abilities Required:
