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Listed below are the top 10 out of 27 listings that are in the same industry and location as the job you were looking for. To see more than 10 listings, click here to search similar jobs in Los Angeles, CA
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Sentry Insurance is one of the country's largest and strongest mutual insurance companies. Sentry was founded in 1904 by members of the Wisconsin Retail Hardware ...
Sentry Insurance is one of the country's largest and strongest mutual insurance companies. Sentry was founded in 1904 by members of the Wisconsin Retail Hardware ...
Sentry Insurance is one of the country's largest and strongest mutual insurance companies. Sentry was founded in 1904 by members of the Wisconsin Retail Hardware ...
Sentry Insurance is one of the country's largest and strongest mutual insurance companies. Sentry was founded in 1904 by members of the Wisconsin Retail Hardware ...
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Western General Insurance Company - Calabasas, CA US
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For your reference, we have included the original job posting below.
Claims Examiner II
Job Number:
23993142
Company Name:
L.A. Care Health Plan
Job Location:
Los Angeles, CA US
Job Category:
Insurance
Claims Examiner II
Claims Examiner II Location: CA-Los Angeles Requisition City: Company Order Number: 635B # of openings: 1
Description
The Claims Examiner II is responsible for the accurate and timely processing of direct contract and delegated claims per regulatory and contractual guidelines, which includes: - Conducts the quality assurance function for the department in concert with the Claims Quality Spec, serve as a back-up Supervisor and resource to other claims examiners. Assists claims examiners with the most difficult cases and caseload issues; serves as peer mentor and provides resource information to other claims examiners. - Acts as a resource for management and staff, provides technical support within area of responsibility. Be able to use logic to analyze or identify underlying principles, reasons, or facts associated with information or data to draw conclusions. - Processing claims for all lines of business, including complex claims - Monitoring itemized billings for excessive charges, duplication, unbundling, and medical coding - Determining prior authorization/precertification of services paid via system and/or health services - Requesting and reviewing medical records as needed for basic information to validate billing information - Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated.
QUALIFICATIONS & REQUIREMENTS
EDUCATION/TRAINING: Required: AA Degree Preferred: BA or BS in business or healthcare-related field EXPERIENCE: Required: - At least seven (7) years of healthcare claims processing experience in a managed care environment. - Excellent experience in handling complicated claims cases. - Ability to operate PC-based software programs or automated database management systems. - Strong communication skills with excellent analytical and problem-solving skills. - Ability to self-manage in a fast-paced, detail-oriented environment. - Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-9, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge. - Moderate knowledge of Microsoft Word and Excel. Preferred: Previous Medi-Cal claims processing experience and knowledge of State Department of Health Services regulations. Must have knowledge of Medicare claims processing. FOREIGN LANGUAGES: Spanish; Chinese (Cantonese or Mandarin) preferred
