Claims Adjuster/Examiner

Title: Claims Examiner (Remote)
Salary Range: $20-$25

Summary
The claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the
contractual obligations of the Health Plans and/or the IPAs. Researches, reviews and contacts provider services
for problem claims and issues, as needed. Suggests process improvements to management and is a resource of
information to all staff.

Duties and Responsibilities

• Accurately review all incoming Provider claims to verify necessary information is available.
• Meets production standards of 100-150 claims as established by claims management
• Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.
• Coordinate resolution of claims issues with other Departments.
• Assist Providers, Members and other Departments in claims research.
• Provide backup for other examiners within the Department.
• Assist in training of new claims personnel.
• Promote a spirit of cooperation and understanding among all personnel.
• Attend organizational meetings as required
• Adhere to organizational policies and procedures.
• Performs other tasks as assigned by supervisor/manager
• Adhere to the core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration

Minimum Job Requirements

• High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system.
• Strong organizational and mathematical skills. Ability to generate claims status reports and/or check runs.

Skill and Abilities

• Experience in a managed care environment preferred.
• ICD-10 and CPT-4 coding knowledge preferred.
• Must be detail oriented and have the ability to work independently

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.