Claims Examiners

Company Job Description/Day to Day Duties:

-Reports to the Director of Claims

-Responsible for the accurate and timely adjudication of all claims in accordance with applicable contracts, state and federal regulations, health plan requirements

-Examiners are expected to produce a minimum of 30 claims per hour.

-Examiners are expected to maintain 98 percent coding and financial accuracy.

-Examiners must meet timeliness requirements for the product line(s) they are responsible for processing. This can be achieved by effectively managing pended items/claims on a daily basis (working them at least two times a day) and by meeting daily production goals.

A. Medicare- 30 calendar days regardless of provider contract status.

B. Medi-Cal- 30 calendar days regardless of provider contract status.

C. Commercial- 60 calendar days regardless of provider contract status.

Minimum Education/Licensures/Qualifications:

-HS/Diploma or GED/equivalent

-1-3+ years of processing of managed care health claims

-Strong knowledge of medical terminology

-Strong Ten Key by touch

-Ability to type at least 40- 45 wpm (if they are unsure of typing skills, please send prove it!)

-Proficient with Microsoft Office/General office equipment experience (i.e. photocopier, fax, calculator, ability to operate a PC)

-Strong working knowledge of ICD.9.CM, CPT, HCPCS, RBRVS coding schemes

-Experience with different software and hardware systems for claims adjudication

-Must have an excellent understanding of health and managed care concepts and their application in the adjudication of claims.

-Must be able to accurately assess financial responsibility and liability for claims submitted by both members and providers.

-Accurate input of data is required for claims adjudication including: diagnostic and procedural coding, pricing schedules, member and provider identification, and all other related information as required.

Best Candidate: 3+ years of experience working on Managed Care claims

2nd Best: 1+ year experience as a Claims Examiner

Location:

15821 Ventura Blvd suite 600

Encino, CA 91436

If Contract, Length of Assignment: RTH

Shift: Monday-Friday, 8am-5pm (There is a night shift, but as of now they are not looking to fill any night spots- if you have a candidate seeking a later shift, I am happy to present them)

Start Date: As soon as all HR is back and clear

Times/Interviewer: Phone interviews with hiring manager- Laura Saez, Claims Supervisor- possible for same day scheduling if not as soon as next day