Talent.com
Medical Claims Adjudicator Analyst (Los Angeles candidates only)

Medical Claims Adjudicator Analyst (Los Angeles candidates only)

Regal Medical GroupLos Angeles, CA, United States
job_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

The Benefits Analyst is responsible of Providing daily leadership and coordination in the maintenance of Regal Medical Group’s claims processing system. Supports accuracy of member benefit set up, assignments, claims processing, financial accuracy and data integrity. Applying analytical skills in improving system automation.

Please note that we are only considering applicants who are local to the Los Angeles area, as this position requires full-time onsite presence at our West Hills, CA office.

Education and / or Experience :

  • Proficiency in Word, Excel, Access, PowerPoint, M.S. Project, Outlook, EZCAP, REA, ClearIQ (TransUnion), PRNLINK, and Encoderpro.
  • Knowledge in SQL Server.
  • Typing / Data entry skills and accuracy.
  • Proficiency in running data queries and data analyzing.
  • Knowledge and experience in Project Management preferred.
  • Excellent time management skills.
  • Outstanding communication skills.
  • Knowledge of Claim adjudication process (Professional & Institutional).
  • Fee schedule knowledge.
  • Diagnosis and procedures codes knowledge preferred.
  • Understanding of the Health Care industry, benefits, and eligibility processes preferred.
  • Medical group or IPA operations and information systems management preferred.
  • Ability to be a problem solver.
  • A bachelor’s degree from a four-college or appropriate industry experience and / or certification preferred.

Essential Duties and Responsibilities include the following :

  • Provides daily oversight of benefits configuration, research and audit.
  • Develops and Implements data integrity initiatives for all supporting system configuration including fee schedules, provider contracts, benefits, eligibility and any other areas that support the effective operation of internal systems.
  • Coordinates with Data Management staff to provide standards be followed and performs random audits.
  • Communicates and implements programs within focused area of responsibility.
  • Communicates, monitors and audits processes and procedures necessary to achieve strategic objectives.
  • Ensure all systems within their area of responsibility are reliable, responsive and support to the needs of the Regal Medical Group network.
  • Develops and fosters a customer satisfaction focused, service mentality within department to strengthen and build relationships with Heritage Provider Network and other Regal Medical Group regions and departments and communicates a balanced view of Data Management importance in relation to other departments and business functions.
  • Supports initiatives that are identified, communicates and negotiates projects with the users and management.
  • Achieves successful delivery of data management deliverables meeting internal and external client needs.
  • Serves as an alternate client liaison for data management benefits issues.
  • Administers and ensures timely completion of all projects.
  • Reviews data management plans for content and structure.
  • Performs other duties as necessary.
  • The pay range for this position at commencement of employment is expected to be $30 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

    The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and / or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

    Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

    If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department / team performance, and market factors.

    As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

    Full Time Position Benefits :

    The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

    Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

    Health and Wellness :

  • Employer-paid comprehensive medical, pharmacy, and dental for employees
  • Vision insurance
  • Zero co-payments for employed physician office visits
  • Flexible Spending Account (FSA)
  • Employer-Paid Life Insurance
  • Employee Assistance Program (EAP)
  • Behavioral Health Services
  • Savings and Retirement :

  • 401k Retirement Savings Plan
  • Income Protection Insurance
  • Other Benefits :

  • Vacation Time
  • Company celebrations
  • Employee Assistance Program
  • Employee Referral Bonus
  • Tuition Reimbursement
  • License Renewal CEU Cost Reimbursement Program
  • Business-casual working environment
  • Sick days
  • Paid holidays
  • Mileage
  • Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

    serp_jobs.job_alerts.create_a_job

    Adjudicator • Los Angeles, CA, United States

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    Mechanic

    Mechanic

    United States ArmyJuniper Hills, CA, US
    serp_jobs.job_card.permanent
    As a Wheeled Vehicle Mechanic, you’ll supervise and perform maintenance, repair, and recovery operations on wheeled vehicles and select armored vehicles that serve the Army in a variety of mission-...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Medical Claims Adjudicator Analyst (Los Angeles candidates only)

    Medical Claims Adjudicator Analyst (Los Angeles candidates only)

    Regal Medical GroupLos Angeles, CA, US
    serp_jobs.job_card.full_time
    The Benefits Analyst is responsible of Providing daily leadership and coordination in the maintenance of Regal Medical Group's claims processing system. Supports accuracy of member benefit set up, a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Medical Claims Adjudicator Analyst (Los Angeles candidates only) (Los Angeles)

    Medical Claims Adjudicator Analyst (Los Angeles candidates only) (Los Angeles)

    Regal Medical GroupLos Angeles, CA, United States
    serp_jobs.job_card.full_time
    The Benefits Analyst is responsible of Providing daily leadership and coordination in the maintenance of Regal Medical Groups claims processing system. Supports accuracy of member benefit set up, as...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Labor & Employment Defense Attorney

    Labor & Employment Defense Attorney

    JobotCalabasas, CA, US
    serp_jobs.job_card.full_time
    No billable requirement! Small-firm culture, high-level practice — grow your career with a firm that blends prestige, impact, and personal mentorship!. This Jobot Job is hosted by : Karyn Spies...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Physician / Internal Medicine / California / Permanent / Remote Medical Director " Prior Authorizati

    Physician / Internal Medicine / California / Permanent / Remote Medical Director " Prior Authorizati

    Integrity Healthcare...Northridge, CA, US
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    While the work is primarily remote, candidates.Review and approve prior authorization requests using clinical guidelines. Collaborate with nurses, physicians, and provider groups to support cost-eff...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Physician Opportunity – Become a California QME (Qualified Medical Evaluator)

    Physician Opportunity – Become a California QME (Qualified Medical Evaluator)

    Expedient Medicolegal ServicesLos Angeles, CA, United States
    serp_jobs.job_card.full_time +1
    Physician Opportunity – Become a California QME (Qualified Medical Evaluator).Expedient Medicolegal Services.Expedient Medicolegal offers physicians a streamlined path into non-clinical roles in th...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Associate Attorney, Workers Compensation

    Associate Attorney, Workers Compensation

    JobotAgoura Hills, CA, US
    serp_jobs.job_card.full_time
    REMOTE - you must live and work in CA!.This Jobot Job is hosted by : Christina Finster.Are you a fit? Easy Apply now by clicking the "Apply Now" buttonand sending us your resume.Salary : $1...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Senior Claims Analyst - Insurance

    Senior Claims Analyst - Insurance

    Insurance ReliefLos Angeles, CA, US
    serp_jobs.job_card.full_time
    Senior Claims Analyst - Insurance - North Hollywood, CA.A growing insurance brokerage, boasting over 25 years of industry leadership and consistent growth, is actively seeking a Senior Claims Analy...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Physician / Family Practice / California / Any / Family Medicine Opportunity in Santa Clarita, CA Jo

    Physician / Family Practice / California / Any / Family Medicine Opportunity in Santa Clarita, CA Jo

    The Inline GroupSanta Clarita, CA, US
    serp_jobs.job_card.full_time
    Hours : Flexible Per Diem, PT, and FT Available.Call Schedule : Very Light Nurse Practitioner Takes First Call.Compensation : $208K - $243K Based on Experience. Benefits : Full-Time Providers will Enjoy...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Business / Business Law Adjunct Instructor Applicant Pool

    Business / Business Law Adjunct Instructor Applicant Pool

    InsideHigherEdSanta Clarita, California, United States
    serp_jobs.job_card.part_time
    We are accepting applications for the Adjunct Business / Business Law Instructor Applicant Pool.Adjunct pools are open on a fiscal year basis for continuous recruitment for department assignments.Ple...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Physician Opportunity - Become a California QME (Qualified Medical Evaluator)

    Physician Opportunity - Become a California QME (Qualified Medical Evaluator)

    Expedient Medicolegal ServicesLos Angeles, CA, US
    serp_jobs.job_card.full_time +1
    Physician Opportunity – Become a California QME (Qualified Medical Evaluator).Expedient Medicolegal Services.Expedient Medicolegal offers physicians a streamlined path into non-clinical roles in th...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Internal Medicine Physician

    Internal Medicine Physician

    Provider HealthcareSimi Valley, CA, US
    serp_jobs.job_card.full_time +2
    Internal Medicine Locum Tenens in California High Pay & Flexibility!.Locum Tenens Internal Medicine Physician.Competitive pay with travel and housing covered. Choose assignments that fit your li...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Emergency Medicine - Woodland Hills

    Emergency Medicine - Woodland Hills

    Kaiser Permanente – Southern California Permanente Medical GroupWoodland Hills, US
    serp_jobs.job_card.full_time +1
    Salary range includes incentives that are contingent upon skills, competencies, and geographic location.The earnings included in the salary range are contingent upon requisite Board Certification.P...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Claims Processing Specialist

    Claims Processing Specialist

    Ultimate StaffingLos Angeles, CA, US
    serp_jobs.job_card.full_time
    We're looking for a detail-oriented Medical Claims Examiner / Claims Specialist to support a reputable organization in El Monte Area. This is great opportunity to use your claims knowledge and analyti...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Claims Processing Specialist (Los Angeles)

    Claims Processing Specialist (Los Angeles)

    Ultimate StaffingLos Angeles, CA, United States
    serp_jobs.job_card.full_time
    We're looking for a detail-oriented Medical Claims Examiner / Claims Specialist to support a reputable organization in El Monte Area. This is great opportunity to use your claims knowledge and analyti...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Claims Adjuster-Los Angeles, CA

    Claims Adjuster-Los Angeles, CA

    StaffingLos Angeles, CA, US
    serp_jobs.job_card.full_time
    Location : Los Angeles, CA Duration : 6 Months.Summary : The main function of a Claims Adjuster is to investigate, analyze, and determine the extent of insurance company's liability to determine how m...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Remote Medical Director - California HealthNet

    Remote Medical Director - California HealthNet

    Centene CorporationTopanga, CA, US
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time +1
    You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified, national organization offe...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    Claims Processing Specialist (Los Angeles County)

    Claims Processing Specialist (Los Angeles County)

    Ultimate StaffingLos Angeles County, CA, United States
    serp_jobs.job_card.full_time
    We're looking for a detail-oriented Medical Claims Examiner / Claims Specialist to support a reputable organization in El Monte Area. This is great opportunity to use your claims knowledge and analyti...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days