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The Senior Claims Examiner administers health plan contracts by processing medical claims in an efficient, cost-effective, and timely manner meeting all required guidelines and performs adjustments as necessary.
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The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCF1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.
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JOB TITLE: Claims Examiner - Days. Unit: Claims Examiner/ 110-85300. Knowledge of compliance issues as they relate to claims processing. Minimum of 2 years claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environment.
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Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims. Training on basic office automation and managed care computer systems. Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services.
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Description: We are looking for a Claims Examiner II/III, depending on their knowledge and experience. In-depth knowledge of Health Plans, IPA, and MSO functions, departments, and claims processing procedures are required.
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A Claims Examiner is responsible for analyzing and the adjudication of medical claims as it relates to managed care. 3+ years of Claims Processing experience in a managed care environment.
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Resolve claims payment issues as presented through Provider Dispute Resolution (PDR) process or from claims incident/inquiries. Responds to provider inquiries/calls related to claims payments.
$26.13 - $32.55 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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This position oversees the claims inventory by setting, evaluating, and monitoring the claims inventory baseline and examiner productivity metrics to ensure the timely and accurate processing of claims in compliance with regulatory requirements and organizational expectations.
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Collaborates with other departments and/or providers in successful resolution of claims related issues. Identifies root causes of claims payment errors and reports to Management. Must have an understanding how to read a CMS-1500 and UB-04 form.
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Assisting Claims Examiner III as needed for special requests. At least 1 year of healthcare claims processing experience in a managed care environment. Previous Medi-Cal or Medicare claims processing experience.
$55,245 - $75,955 a yearTemporaryExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Job Description: The claims examiner reports directly to the claims manager. Job Description: The claims examiner reports directly to the claims manager. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change.
$24 an hourExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Job Title: Claims Processor. Experience in interpreting provider contract reimbursement terms desirable. Must have physical proof on hand if background check is unable to verify your education background.
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Facilitate exchanges of information between the grievance, claims processing, and provider relations systems. Analyze trends in claims processing issues, assisted with identifying and quantifying issues and reviewed the work process.
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SHIFT: Monday - Friday - 07:00am - 03:30pm. Required + Booster - Medical/Religious Exemptions and Declinations Allowed. No branding or agency identifiers on the resume. Explanations of any work history gaps of 90+ days within the chronology of the resume.
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