Temporary Claims Examiner I - Fairfield, United States - Partnership HealthPlan of California

Partnership HealthPlan of California Fairfield, United States

3 weeks ago

Description

Overview:

To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters. Routes and tracks claims requiring review by other staff and departments, and processes when possible.

Responsibilities:

Reviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims within established production and quality standards. Completes claims from the Batch Error Report and Batch Pass Report.
Routes claims to appropriate PHC departments and internal staff for additional review. Follows up and completes claims once response to request has been received.
Follows established PHC policies and procedures, PHC Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims.
Generates claims correspondence as needed.
Records daily production statistics and related activities on appropriate reports. Turns in all logs and reports to the Medi-Cal Claims Supervisor.
Reviews all work audits in a timely manner and submits any adjustments and corrections within the allotted time frame.
Supports Claims Departments needs for resolving all pended claim types.
Participates in special projects and assignments as required.
Other duties as assigned.

Qualifications:

Education and Experience

High school diploma or equivalent; prior experience examining claims in an automated environment; or equivalent combination of education and experience.

Special Skills, Licenses andCertifications

Effective written and oral communication skills. Good organization skills.

Performance Based Competencies

Ability to effectively exercise good judgement within scope of authority and handle sensitive issues with tact and diplomacy. Ability to stay focused on repetitive work and meet production and quality standards. Ability to accurately complete tasks within established timelines.

Work Environment And Physical Demands

Ability to use a computer keyboard. More than 80% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 5 lbs.

All HealthPlan employees are expected to:

Provide the highest possible level of service to clients;
Promote teamwork and cooperative effort among employees;
Maintain safe practices; and
Abide by the HealthPlans policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$22.00/hour

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Claims Examiner II

3 weeks ago

Partnership HealthPlan of California Fairfield, United States

Overview: · To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Completes and processes claims and claims worksheets. Creates appropriate documentation that reflects the actions ta ...
Claims Examiner

4 weeks ago

NESCO Inc Concord, United States

PRIMARY PURPOSE: To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practice ...
TPA Claims Examiner

3 days ago

Schifrin, Gagnon, & Dickey, Inc. (SGD, Inc.) Concord, United States

· Are you a detail-oriented and enthusiastic claims professional? Join our team at SGD as a TPA Claims Examiner, working remotely. You will play a crucial role in evaluating insurance claims and facilitating the resolution process for our clients. This position requires excellen ...
TPA Claims Examiner

3 weeks ago

Schifrin, Gagnon, & Dickey, Inc. (SGD, Inc.) Concord, United States

· Are you a detail-oriented and enthusiastic claims professional? Join our team at SGD as a TPA Claims Examiner, working remotely. You will play a crucial role in evaluating insurance claims and facilitating the resolution process for our clients. This position requires excellen ...
Tpa Claims Examiner

1 week ago

Schifrin, Gagnon, & Dickey, Inc. (SGD, Inc.) Concord, United States

Are you a detail-oriented and enthusiastic claims professional? Join our team at SGD as a TPA Claims Examiner, working remotely. You will play a crucial role in evaluating insurance claims and facilitating the resolution process for our clients. This position requires excellent c ...
Tpa Claims Examiner

2 days ago

Schifrin, Gagnon, & Dickey, Inc. (SGD, Inc.) Concord, United States

Are you a detail-oriented and enthusiastic claims professional? Join our team at SGD as a TPA Claims Examiner, working remotely. You will play a crucial role in evaluating insurance claims and facilitating the resolution process for our clients. This position requires excellent c ...
Senior Claims Examiner

3 weeks ago

Berkley Walnut Creek, United States

Company Details: · Berkley Enterprise Risk Solutions will offer specialized workers compensation solutions to California-based clients with sophisticated risk management capabilities and interests. We are pleased to be expanding our expertise to this segment of the market with d ...
Claims Examiner III

3 weeks ago

Tristar Insurance Services LLC Concord, United States

Job Details · Level · Experienced · Job Location · Concord Office - Concord, CA · Remote Type · Hybrid · Position Type · Full Time · Education Level · High School Diploma or GED · Salary Range · $90, $95,000.00 Salary/year · Travel Percentage · None · Job Shift · D ...
Workers Compensation Claims Examiner

1 week ago

Sedgwick Claims Management Services Concord, United States

To analyze California Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Workers Compensation, Claims, ...
Workers Compensation Claim Examiner

1 week ago

Sedgwick Claims Management Services, Inc. Concord, United States

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
Workers' Compensation Claims Examiner

1 week ago

Sedgwick Claims Management Services, Inc. Concord, United States

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
Workers Compensation Claims Examiner

1 week ago

Sedgwick Concord, United States

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
Workers Compensation Claim Examiner

3 weeks ago

Sedgwick Concord, United States

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
Workers Compensation Claims Examiner

3 weeks ago

Sedgwick Concord, United States

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
Workers Compensation Claims Examiner

3 days ago

Sedgwick Concord, United States

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
Library Technician

3 weeks ago

US Air Mobility Command Travis AFB, United States

**Duties**: · - Assists in the training of new library aides and technicians on circulation tasks. Independently performs circulation and registration duties by implementing established procedures for circulation functions. · - Maintains automated and/or manual circulation files ...
Bartender

1 week ago

US Air Mobility Command Travis AFB, United States

**Duties**: · - Operates a full service bar. · - Mixes and serves all types of alcoholic or nonalcoholic drinks to order, following a variety of established recipes. · - Receives payments or charges to member's account as appropriate. · - Responsible for the proper operation of t ...
Workers' Compensation Claims Adjuster Ii

3 weeks ago

County of Contra Costa, California Martinez, United States

**The Position**: · **Bargaining Unit: Local 21 - Non-Supervisory Management** · Contra Costa County is seeking two (2) Workers' Compensation Claims Adjuster II to join our Risk Management team. The County Workers' Compensation Program is unique as it is not only self-insured, bu ...
Accounting Technician

1 week ago

City of Vallejo, CA Vallejo, United States

**Description**: · **THE POSITION** · - This recruitment is being conducted to fill one full-time vacancy. The list established by this recruitment may be used to fill future full-time, part-time, limited term, and temporary vacancies for up to one year. · - The Accounting Techni ...
Geographic Information Systems Technician

1 week ago

County of Contra Costa, California Martinez, United States

**The Position**: · **Bargaining Unit: Teamsters Local 856** · DoIT will allow you an opportunity to thrive in an environment where you get to see new technology challenges each day while interfacing with various organizational leaders at all levels of county leadership. DoIT is ...