Current jobs related to Medical Claims Examiner - Fresno CA - TEKsystems Careers
-
Workers Compensation Claims Examiner
7 days ago
Long Beach, CA, United States Sedgwick Claims Management Services Full timeJob SummaryWe are seeking a skilled Workers Compensation Claims Examiner to join our team at Sedgwick Claims Management Services.Key Responsibilities:Analyze mid- and higher-level workers compensation claims to determine benefits due.Ensure ongoing adjudication of claims within company standards and industry best practices.Identify subrogation of claims and...
-
Medical Claims Examiner
7 days ago
Long Beach, CA, United States Ultimate Staffing Full timeJob Summary:This position is open to Hybrid candidates in the greater Long Beach/Los Angeles area. We are seeking a skilled Medical Claims Examiner to join our team at Ultimate Staffing.Responsibilities:• Audit claims processing quality and develop standard reports• Assist the Claims Supervisor/Director in reviewing quality auditing tracking/reporting...
-
Workers Compensation Claims Adjuster
2 days ago
Fresno, United States TheBest Claims Solutions Full timeOur client, is looking for multiple Workers' Compensation Examiners to join their team. These positions are Direct Hire and will be a hybrid schedule, reporting to an office near Fresno, CA.Required Qualifications:2+ years of California Workers' Compensation Indemnity Claims ExperienceExperience handling litigated and non-litigated filesAbility to handle...
-
Workers Compensation Claims Adjuster
22 hours ago
Fresno, United States TheBest Claims Solutions Full time $75,000 - $85,000Our client, is looking for multiple Workers' Compensation Examiners to join their team. These positions are Direct Hire and will be a hybrid schedule, reporting to an office near Fresno, CA.Find out exactly what skills, experience, and qualifications you will need to succeed in this role before applying below.Required Qualifications:2+ years of California...
-
Claims Examiner/Adjuster
1 week ago
Anaheim, CA, United States DB Insurance Full timeJob Title: Claims Examiner/AdjusterCompany Overview:DB Insurance Co Ltd (US Branch) is a leading insurance company seeking a full-time Claims Examiner/Adjuster to handle Commercial General Liability/Auto BI Liability claims.About DB Insurance:DB Insurance Co., Ltd. is one of the largest non-life insurance companies based in South Korea. DB Insurance Co.,...
-
Claims Examiner II
6 days ago
Fairfield, CA, United States Yoh Full timeClaims Examiner II: needed for a contract opportunity with Yoh's client located in Redding, CA!Top Skills You Should Possess:High school diploma or equivalent; minimum one (1) year in Medi-Cal billing and/or claims examining experience in an automated environment.What You'll Be Doing:Reviews, researches, and resolves pended claims for Medi-Cal types:...
-
Medical Claims Specialist
7 days ago
Fresno, California, United States TEKsystems Full timeJob Summary:The Medical Claims Specialist will be responsible for following up on identified government and non-government claims, including Medicare and Medicaid. This role requires a strong understanding of medical terminology and insurance processes.Key Responsibilities:Review eligibility and verify insurance benefits to generate clean claims.Modify and...
-
Medical Claims Specialist
1 week ago
Fresno, California, United States TEKsystems Full timeJob Title: Medical Claims SpecialistJob Summary:TEKsystems is seeking a skilled Medical Claims Specialist to join our team. As a Medical Claims Specialist, you will be responsible for following up on identified government and non-government claims, including Medicare and Medicaid. You will resolve unpaid accounts in a timely and efficient manner, maintaining...
-
Medical Claims Specialist
2 weeks ago
Fresno, California, United States TEKsystems Full timeJob SummaryWe are seeking a skilled Medical Claims Specialist to join our team at TEKsystems. As a Medical Claims Specialist, you will be responsible for processing and managing medical claims, ensuring timely and accurate payment to healthcare providers.Key ResponsibilitiesReview and verify insurance benefits to ensure accurate claims processingProcess and...
-
Medicaid Medical Claims Specialist
1 week ago
Fresno, California, United States TEKsystems Full timeJob Summary:The Medicaid Medical Claims Specialist is responsible for the follow-up on identified government and non-government claims, including Medicare and Medicaid. This role requires a high level of attention to detail and organizational skills to ensure timely and efficient resolution of unpaid accounts. The incumbent will work in a team environment to...
-
Claims Adjuster
2 weeks ago
Fresno, California, United States Intercare Holdings Insurance Services Full timeJob Title: Claims AdjusterAt Intercare Holdings Insurance Services, we're seeking an experienced and motivated Claims Adjuster to join our team in Fresno. As a Claims Adjuster, you'll work closely with our team of 7, including 5 Claims Adjusters and 2 Claims Examiners, to ensure exceptional claim handling and adherence to company standards and...
-
Claims Administrative Specialist I
2 weeks ago
Fresno, California, United States Zenith Full timeJob SummaryAs a Claims Administrative Specialist I at Zenith, you will play a vital role in supporting the claims function by performing routine but varied medical administrative duties of moderate complexity. Your responsibilities will include intake of treatment requests for multi-state jurisdictions, IMR processing, reviewing medical reports and RFA's for...
-
Physician Assistant
7 days ago
Fresno, California, United States QTC Company Full timeJob SummaryWe are seeking a highly skilled Physician Assistant to join our team at QTC Medical Group Inc. in Fresno, CA. As a Physician Assistant, you will play a vital role in the continued care of our service members, conducting a variety of general medicine, occupational, and disability health examinations.Key ResponsibilitiesConduct general medicine,...
-
Medical Claims Customer Service Representative
2 weeks ago
Fresno, California, United States TEKsystems Full timeJob Summary:As a Medical Claims CSR at TEKsystems, you will be responsible for providing exceptional customer service to our members, resolving claim issues, and ensuring timely and accurate processing of medical claims. Key Responsibilities: Quotes benefits to members, IPA/HMO providers, and non-IPA providers. Verifies member eligibility and resolves claim...
-
Claims Examiner
1 week ago
Ontario, CA, United States Sedgwick Full timeAt Sedgwick, we prioritize taking care of our colleagues and providing a culture of caring. This means offering flexibility and time for personal pursuits, as well as opportunities for growth and skill development. Our team is dedicated to making a positive impact on the world through our work with clients and communities.Key Responsibilities:Analyze and...
-
Fresno, California, United States TEKsystems Full timeJob SummaryWe are seeking a skilled Medical Claims CSR to join our team at TEKsystems. As a Medical Claims CSR, you will be responsible for resolving member/provider claim issues, logging member ER visits in the UR computer file, and providing qualified, responsible, and professional assistance to our clients.Key ResponsibilitiesResolve member/provider claim...
-
Claims Adjuster
3 weeks ago
Fresno, California, United States Intercare Holdings Insurance Services Full timeJob Title: Workers Compensation Claims AdjusterWe are seeking an experienced and motivated Workers Compensation Claims Adjuster to join our team at Intercare Holdings Insurance Services.About the Role:As a Claims Adjuster, you will work within a team of professionals to ensure exceptional claim handling and adherence to company standards and regulations.Key...
-
Property Claims Adjuster
4 weeks ago
Fresno, California, United States Crawford & Company Full timeJob SummaryUnder limited supervision, resolves all types of the most serious losses, heavy commercial property losses or other assigned losses by investigating, negotiating settlements, presenting evidence in legal proceedings while maintaining high production levels; makes sales calls and presentations when requested.Key ResponsibilitiesExamines claims...
-
Claims Adjuster
2 weeks ago
Folsom, CA, United States George Hills Company Full timeJob SummaryGeorge Hills Company is seeking a highly skilled Claims Adjuster to join our team. As a Claims Adjuster, you will be responsible for investigating, evaluating, and adjusting General and Automobile Liability claims.Key ResponsibilitiesInvestigate and analyze claims to determine the extent of insurance provider's liabilityCorrespond with claimants,...
-
Claims Resolution Specialist
1 week ago
Fresno, California, United States Intercare Holdings Insurance Services Full timeClaims Resolution Specialist OpportunityWe're seeking an experienced and motivated Claims Resolution Specialist to assist our team in providing exceptional claim handling and adherence to company standards and regulations.Our Mission:To be the leading third party administrator offering professional and technological resources through pro-active and...
Medical Claims Examiner
2 months ago
The Claims Examiner I reports to the Superviosr of Claims. Claims Examiner I is responsible for reviewing and processing medical, dental, vision and electronic claims in accordance with state, federal and health plan regulatory requirements, department guidelines, as well as meet established quality and production performance benchmarks to include research and review of applicable documentation. The incumbent will also process Health Insurance Payment Demand (HIPD) claims. The Claims Examiner I will thoroughly review, analyze, and research health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. The position will assist in resolving issues from providers, customer service, member services, health plan, and other internal customers.
*High school education or equivalent: minimum one (1) to three (3) years year of experience as a Health Claims Examiner or comparable industry experience preferrecd.
• A minimum of one (1)year experience as a Claims Examiner for medical, dental claims and vision, subrogation, and accident claims
• Ability to interpret Plan Documents or Summary Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination
• Basic knowledge of medical terminology. Proficient in 10-key by touch data entry/type 40 WPM and Microsoft Office (Word, Excel, Outlook, PowerPoint) and possess a capability to quickly learn new applications.
• Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines.•
Examine a problem, set of data or text and consider multiple sides of an issue, weighs consequences before making a final decision.
• Ensure compliance with all appropriate policies and practices, local, State, Federal regulations and requirements regarding claims and contract administration.
• Partner with peers to document and analyze functional requirements, identify gaps and alternative approaches to resolve problems.
• Contribute to defining and documenting standards and periodically reviewing them to integrate appropriate industry standards.
• Alert supervisors to potential higher risk compliance issues
• We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
