Current jobs related to Claims Examiner I - Los Angeles - L.A. Care Health Plan
-
Claims Examiner
2 weeks ago
Los Angeles, California, United States MedPOINT Management Full timeJob SummaryMedPOINT Management is seeking a highly skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for accurately reviewing and processing medical claims in accordance with regulatory guidelines and company policies.Key ResponsibilitiesReview and verify incoming provider claims to ensure all necessary information is...
-
Claims Examiner
4 months ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob Description Summary:Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge of medical terminology necessary. Strong knowledge of Commercial, Medicare and Medi-Cal codes. Basic PC knowledge with...
-
Claims Examiner
3 months ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob Description Summary:Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge of medical terminology necessary. Strong knowledge of Commercial, Medicare and Medi-Cal codes. Basic PC knowledge with...
-
Claims Examiner
2 months ago
Los Angeles, United States Preferred IPA of California Full timeJob DescriptionJob DescriptionGENERAL SUMMARYThe Claims Examiner position is primarily responsible for the accurate and timely adjudication of paper and/or electronically formatted claims received in the CMS 1500 and/or UB-04 format. The Examiner processes all claims and applicable claims correspondence in accordance with Medicare and Medi-Cal regulatory...
-
Claims Examiner
2 months ago
Los Angeles, United States Preferred IPA of California Full timeJob DescriptionJob DescriptionGENERAL SUMMARYThe Claims Examiner position is primarily responsible for the accurate and timely adjudication of paper and/or electronically formatted claims received in the CMS 1500 and/or UB-04 format. The Examiner processes all claims and applicable claims correspondence in accordance with Medicare and Medi-Cal regulatory...
-
Hospital Claims Examiner
4 months ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob DescriptionThe claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospital Client. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is...
-
Hospital Claims Examiner
3 months ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob DescriptionThe claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospital Client. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is...
-
Claims Investigator-Examiner
3 weeks ago
Los Angeles, United States AIDS Healthcare Foundation Full time $30 - $32Job DescriptionJob DescriptionOverviewAMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its...
-
Insurance Claims Examiner
2 weeks ago
Los Angeles, California, United States MedPOINT Management Full timeJob SummaryWe are seeking a highly detail-oriented and organized Claims Processor to join our team at MedPOINT Management. As a Claims Processor, you will play a critical role in ensuring the accurate review and processing of claims in accordance with regulatory requirements and organizational standards.Key ResponsibilitiesVerify the completeness and...
-
Associate Bond Claims Examiner
1 month ago
Los Angeles, United States Tokio Marine HCC Full timeClaims Examiner Los Angeles, CA - On-site Tokio Marine HCC - Surety Group, a member of the Tokio Marine Group of Companies, has an exciting opportunity for an Associate Claims Examiner position on-site at our office in Los Angeles, California. Do you have good investigative instincts? Are you highly skilled with written communications, grammar, spelling,...
-
Claims Examiner
3 days ago
Los Angeles, California, United States Command Investigations Full timeClaims Investigator Job DescriptionWe are seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required.Key Responsibilities:Taking in-person recorded statementsScene photosWriting a detailed, comprehensive reportClient...
-
Claims Examiner
3 weeks ago
Los Angeles, United States Synectics Full timeDescription : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of...
-
Healthcare Claims Analyst I
3 weeks ago
Los Angeles, California, United States Insight Global Full timeInsight Global is seeking a dedicated Healthcare Claims Analyst I to join our team. This role is essential for managing and resolving claims inquiries effectively. The Healthcare Claims Analyst will engage with members via phone, addressing any billing or claims issues they may encounter. This position involves: Responding promptly to scheduled reports and...
-
Property Claim Representative
4 days ago
Los Angeles, California, United States VetJobs Full time{"title": "Property Claim Representative", "subtitle": "Handle First-Party Property Claims", "content": "We are seeking a skilled Property Claim Representative to join our team at VetJobs. As a key member of our claims team, you will be responsible for handling first-party property claims of high severity and complexity."}, { "title": "Insurance Claims...
-
Claims Review Specialist
3 weeks ago
Los Angeles, California, United States MedPOINT Management Full timePosition Overview:We invite you to explore an exciting opportunity with MedPOINT Management as a Claims Examiner. This role is essential for ensuring the accurate processing and evaluation of provider specialty claims.Role Summary:The Claims Examiner will be responsible for the meticulous review, input, and adjudication of provider specialty claims,...
-
Specialty Claims Reviewer
3 weeks ago
Los Angeles, California, United States MedPOINT Management Full timeJob Overview:We invite you to explore an exciting opportunity with MedPOINT Management as a Claims Examiner. Please review the details below to understand the responsibilities and qualifications required for this role.Position Summary:The Claims Examiner will be responsible for the meticulous evaluation, input, and adjudication of provider specialty claims,...
-
Claims Assessment Specialist
3 weeks ago
Los Angeles, California, United States MedPOINT Management Full timeJob OverviewSummary:Effectively manage, evaluate, and process provider specialty claims, including UB04 forms, in accordance with external regulations, internal protocols, and contractual obligations. A solid grasp of medical terminology is essential. Extensive knowledge of Commercial, Medicare, and Medi-Cal coding is required. Basic computer proficiency is...
-
Healthcare Claims Analyst
3 weeks ago
Los Angeles, California, United States MedPOINT Management Full timePosition OverviewThe Healthcare Claims Analyst plays a crucial role in the evaluation and processing of claims, ensuring compliance with external regulations and the contractual commitments of MedPOINT Management and its healthcare partners. This position involves thorough research, review, and communication with provider services to resolve claim-related...
-
Senior Claims Specialist
17 hours ago
Los Angeles, California, United States Chubb Full timeJob DescriptionThis is a challenging and rewarding role that requires a unique blend of analytical skills, technical knowledge, and interpersonal abilities. As a Senior Claim Specialist in our Employment Practices Liability team, you will be responsible for resolving complex workplace claims, working closely with defense counsel and insureds to achieve early...
-
Hospital Claims Auditor
3 months ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob DescriptionSummary:A Hospital Claims Auditor is responsible for the overall quality of claims processes as well as compliance, in accordance with outside regulations and the contractual obligations of the Health Plans and/or Hospital Clients. Research, reviews and contacts provider services for problem claims and issues, as needed....
Claims Examiner I
4 months ago
Salary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Claims Examiner is responsible for the accurate and timely processing of direct contract and delegated claims per regulatory and contractual guidelines, which includes:
* Processing claims for all lines of business, including complex claims
* Monitoring itemized billings for excessive charges, duplications, 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.
*Meeting and exceeding performance measurements for Claim Examiners as required by department to meet regulatory compliance.
DutiesProcess incoming claims: Determine correct level of reimbursement based on established criteria, provider contract, participating provider group, health plan and regulatory provisions. Process all claims eligible or ineligible for payment accurately and conforming to quality, production standards and specifications in a timely manner. Document provider claims/billing forms to support payments/decisions. Negotiate reimbursement amounts for out-of-network claims. Identify dual coverage, Potential third party savings/recovery. Maintain department databases used for report production and tracking on-going work. Claims are processed within the contractual and/or regulatory time frames within or less than 45 working days and as supported by the departmental policies. (60%)
Perform special projects and ad-hoc reporting as necessary. Projects are complete and reports are generated within the specific time frame agreed upon at the time of assignment. (15%)
Assist management with in-house and on-site training as offered to employees, contracted partners and providers. (5%)
Work with internal departments to resolve issues preventing claims processing or enhancing processing capabilities. May assist in testing, changing, analyzing and reporting of specific enhancements. (5%)
Attend meetings as required. Claims Department/Operations Division is represented at internal and external meetings. (5%)
Perform other duties as assigned. (10%)
Duties Continued Education Required High School Diploma/or High School Equivalency CertificateEducation Preferred Experience
Required:
At least 6 months of healthcare claims processing experience in a managed care environment.
Preferred:
Previous Medi-Cal and EDI claims processing experience a plus.
Skills
Required:
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-10, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge.
Moderate knowledge of Microsoft Word and Excel.
Preferred:
Knowledge of State Department of Health Services regulations.
Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements LightAdditional InformationSalary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)