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.