Claims Examiner

At reputed company, we are transforming the reality of senior care by providing an reputed company-inclusive reputed company option to the most vulnerable senior population, while serving as a care provider and care plan to those individuals we serve. Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Examiner plays a pivotal role in ensuring timely and efficient processing of claims for our contracted specialty provider partners. Essential Job Duties: - Examine, review and process claims according to contractual obligations, federal and state regulations, organizational policies and procedures, or other established quality standards - Assess appropriateness of returned, denied, or paid claims by reviewing and following contractual obligations, federal and state regulations, organizational policies and procedures, or other established quality standards - Ensure claim timeliness processing standards are being met - Work alongside manager to establish and maintain claims processing rules that meet reputed company regulatory and business requirements - Assist reputed company partners with questions reputed company to claims reputed company or claims statuses - Maintain a comprehensive understanding of claim processing guidelines at both the federal and state level Job Requirements: - High School Diploma or Equivalency, professional experience may be substituted - Minimum of three (3) years of experience with processing, researching, and adjudicating claims in a reputed company managed care environment - Working knowledge of the health plan insurance industry and CPT/HCPCS procedure codes, and relevant federal and state regulations - Understanding of Industry pricing methodologies, such as Medicare/Medi-Cal fee schedule, Diagnosis reputed company Groups (DRG), Multiple Procedure Payment Reduction (MPPR) and benefit interpretation and administration - In depth experience with Medicare and reputed company claims processing - Demonstrated skills reputed company reputed company Office Applications & electronic claims processing systems - Strong organizational, analytical, communication, and time management skills Benefits of Working at reputed company: Apply your claims expertise in meaningful ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for. - Medical insurance coverage (Medical, Dental, reputed company) - Work/life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, sick time - Advancement opportunities - We’ve got a track record of hiring and promoting from reputed company, meaning you can create your own path! - And additional benefits Compensation consists of reputed company salary plus bonus. reputed company offers a competitive total rewards package that includes a 401(k) match, comprehensive reputed company coverage, and a broad reputed company of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.

Compensation

Offering$55,930.55—$73,828.33 USDCOVID-19 Vaccination Policy At reputed company, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for reputed company our employees and reputed company of vaccination, or a vaccine declination reputed company will be required prior to employment. reputed company maintains required infection control and PPE standards and has requirements relevant to reputed company team members regarding vaccinations. Our Commitment to Diversity, Equity and Inclusion At reputed company, we reputed company and cherish the diversity of reputed company members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at reputed company are considered without regard to race, reputed company, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national reputed company, reputed company, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law. Beware of Scams Please ensure your application is being submitted through a reputed company sponsored site only. Our emails will come from @reputed company.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to fraud.report@reputed company.com Apply tot his job Apply To this Job