Contract Claims Examiner III

Location: Monterey Park, CA
Date Posted: 07-11-2017

Job Responsibilities:

Identified Talent Solutions, is actively seeking a Claims Examiner III for a 2-month CONTRACT opportunity at one of our healthcare partners serving the Monterey Park, CA community.  
Our client is a market-leading healthcare organization specializing in government-sponsored programs.  They are dedicated to innovating healthcare and their mission is to transform the healthcare system by rewarding high-quality and cost-effective care.
The Claims Examiner III will perform an accurate review, input, and adjudication of provider specialty claims, including UB-92's, in accordance with outside regulations, internal production standards, and the contractual obligations. Knowledge of medical terminology necessary. Strong knowledge of Commercial, Medicare and Medi-Cal codes. Basic PC knowledge with the ability to research, review and contact providers for problem claims.

Reporting Responsibilities
  • Meets production standards of 100-150 Hospital claims per day and 200-250 IPA claims as established by claims management
  • Assists in other IPA's when needed
  • Submits automation requests through SharePoint
  • Process Customer Care Inquiries
  • Reviews pre-check run reports and/or Reviews and releases pended claims from the PEND buckets (ELIG, AUDIT, MGR, UM, CLER, etc.)
  • Assists with training new hires
  • Performs other tasks as assigned by supervisor/manager
  • Attends training meetings and ask questions
  • Provides auditor with training suggestions/example
  • Submits training survey after each training
  • Adhere to Claims Department policies and procedures. Keeps updated materials and resources provided for accurate and expedient adjudication
  • Ensure that the Examiner's Checklist is verified and done

Position Requirements:
Required Experience/Skills:
  • 3 years’ experience as a Claims Examiner with strong organizational and mathematical skills required
  • Must be able to communicate with others clearly, tactfully and professionally
  • Must have a high school diploma or equivalent
  • Must be detail oriented
  • Must have strong computer skills with a broad knowledge of software packages. Must be able to follow directions and perform independently according to departmental standards when no directions are given
  • Must possess effective communication skills. Must be able to willingly accept responsibility and possess the desire to learn new tasks
  • Must speak, ready and write English

Education: High School or equivalent

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