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Claims Examiner

Camarillo, CA

Temp-Hire

$DOE

Essential Functions

  • Responsible for the accurate processing and completion of claims upon first receipt.

  • Process basic types of claims within current turnaround standards.

  • Responsible for applying correct pricing mechanism to claims.

  • Reviews and monitors pended claims reports as applicable and appropriate.

  • Process adjustment requests.

  • Ability to understand and apply health plan concepts to include: contract language, benefit interpretation, COB, multiple surgery reduction, bilateral surgery pricing, co-insurance, out of pocket/lifetime maximums.

  • Refers claims review requests that require professional medical necessity to nurse or Medical Director for review and determination in an appropriate and consistent manner.

  • Documents applicable information to support claims determinations.

  • Generate member and provider communications as needed.

  • Must meet productivity goals of processing a minimum 150 to 180 claims per day with no more than a 2% error rate

Experience

  • Minimum one to two years’ prior experience examining claims in an automated healthcare setting; or equivalent combination of education and experience.

Please apply at:

OnDemand Employment Group

2011 Auto Center Drive #116

Oxnard 93036

P:805 485-4606

F:805-485-4607

E: ODEGJOBS@gmail.com
Please bring with you 2 (two) forms of valid identification and an updated resume.

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