Claims Representative

Job Description

Job Description

We are looking for a detail oriented Entry-level Claims Representative to join our clients' team in Ontario, California. In this role, you will provide critical support in managing claims-related tasks, ensuring accuracy and efficiency in processing, reconciling, and auditing claims. This is a long-term contract position ideal for professionals with strong organizational skills and a background in medical office operations.

Responsibilities :

• Match checks with remittance advice, prepare and insert them into envelopes for mailing.
• Reconcile processed batches within the audit database to ensure accuracy.
• Create and mail denial trailers and letters to providers.
• Print and send out claim requirement letters for Covered California members.
• Forward claims to the appropriate health plan when necessary.
• Process and mail claims deemed unable to process, including generating the necessary correspondence.
• Batch trailers created by various departments and ensure proper documentation.
• Audit the batch log key to confirm claims have been assigned and logged correctly.
• Verify member information to determine line of business and coordination of benefits in the system.
• Collaborate on process adjustments and work independently or as part of a team.
• High school diploma or equivalent education.
• Minimum of six months of experience in a medical office setting.
• Proficiency in data entry with accuracy and speed, typing 35-40 words per minute.
• Familiarity with Microsoft Excel, Word, and Outlook.
• Knowledge of claim forms, including UB-04 and CMS-1500.
• Strong attention to detail and ability to adapt to changing processes.
• Excellent communication skills and ability to work collaboratively.
• Understanding of benefits coordination and health plan operations.