Claims Examiner

Are you an experienced Claims Examiner looking for a new opportunity with a prestigious healthcare company in the San Fernando, CA  area? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

The ideal person for this position would have 1+ year of Managed Care claims experience. In this role you will be responsible for the accurate & timely adjudication of all claims in accordance with applicable contracts, state & federal regulations, health plan requirements, policies & procedures.

Key Responsibilities:

Analyzes professional &/or hospital claims for accuracy according to set dollar thresholds, meets & maintains production & quality standards

Reviews authorization &/or provider's contract & adjudicates claims accordingly

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

Performs any correspondence, follow up & any projects delegated by claims supervisor

Knowledge, Skills & Abilities:

Understanding of health & managed care concepts & their application in the adjudication of claims

Strong working knowledge of ICD9 CM, CPT, HCPCS, RBRVS coding schemes & medical terminology

Minimum Qualifications:

Monday - Friday schedule & competitive pay!