Responsible for consistently and accurately adjudicating claims in accordance with policies, procedures and guidelines as outlined by company policy.
Process claims according to all CMS and DMHC guidelines. Provide expertise or general claims support by reviewing and processing claims.
Authorize appropriate payment or refer claims to leads or supervisors for further review. Analyze and identify trends and provides reports as necessary.
Consistently meet established productivity, schedule adherence, and quality standards. Provide excellent customer service.
Accurately process professional and hospital claims. Analyze and adjudicate claims to ensure accurate payment. Interfaces with other departments to obtain necessary information required for resolution of claims.
Advise management of any claim issues or inappropriate and / or incorrect billing. Other duties assigned by management.1+ years' experience as a Medical Claims Examiner working on 'Professional or Hospital' claims.
Solid experience with ICD9 and 10. Knowledge of DOFR Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product.
Prior Medicare, Commercial, ERISA or HMO experience. Working knowledge of Medical Terminology and CPT4. Proficient experience with Word and Excel.
Excellent Data Entry skills / Computer literate.
Medical Claims
Medical Claims Examiner working on 'Professional or Hospital' claims. Provide expertise or general claims support by reviewing and processing claims. Responsible for consistently and accurately adjudicating claims in accordance with policies, procedures and guidelines as outlined by company policy. ...
Sr. Medical Malpractice Claims Manager - Professional Liability *Remote*
Have direct responsibility to foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists. Medical Malpractice Claims Manager - Professional Liability who will:. Develop a plan of action for assigned...
Legal Billing Specialist(Multiple, across US offices)
The Billing Specialist is responsible for providing general support to the billing team including, but not limited to, time narrative entry and edits, corrections and edits to invoices, compiling expense back-up for invoice submissions, filing and other administrative functions. Aderant, Elite, Bill...
Claims Adjuster - Workers Compensation
Our client, a leading financial services company is hiring a Claims Adjuster - Workers Compensation on a long-term contract basis. The main function of a Workers' Compensation Claims Adjuster is to investigate, analyze, and determine the extent of insurance company's responsibility for lost wages, m...
Billing Specialist
Must-Haves for the Billing Specialist Role:. Minimum of two (2) years of experience in medical insurance billing: Experience should ideally be in facility billing to ensure familiarity with the relevant processes. Strong understanding of billing and coding guidelines: The candidate must have a solid...
Remote Claims Analyst
A-Line Staffing is now hiring a Remote Claims Analyst in Sacramento, CA. The Remote Claims Analyst would be working for a Fortune 500 company and has career growth potential. If you are interested in this Remote Claims Analyst position, please contact Austin Faris. Remote Claims Analyst Highlights. ...
Claims Adjuster Workers Compensation
PRIMARY PURPOSE:** To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements. Claims Adjuster Workers Compensat...
Sr Billing & Project Accounting Specialist
Gannett Fleming is seeking a Sr Billing & Project Accounting Specialist. Additionally, the specialist will compile invoice packets to meet client requirements, which may include timesheet and expense documentation, DBE reporting, client-required forms, and Project Manager progress reports. Input new...
Group Claims Specialist - West Coast (mst/pst)
We are excited to bring on a highly motivated Group Claims Specialist to support our ever-growing claims organization in a work from home environment. As a Group Claims Specialist, you will support our Short Term Disability or Integrated Absence teams. SYiXOPSII) of a Claims Specialist at Lincoln Fi...
Workers' Compensation Claims Adjusters
Four (4) to five (5) years of experience, within the last five (5) years, adjusting workers' compensation claims, including one (1) year adjusting complex litigated claims, such as continuous trauma, AOE/COE, stress claims, and safety claims. Compensation Claims Adjusters. Workers' Compensation Clai...