Claims Examiner II

4 weeks ago

Pasadena, United States Imperial Health Plan of California, Inc. Full time

ESSENTIAL JOB FUNCTIONS:

  • Adjudicates complex professional and institutional claims.
  • Responsible for meeting performance measurement standards for productivity and accuracy.
  • Adjudication of claims adjustment.
  • Follow all appropriate Federal and State regulatory requirements and guidelines applicable to HealthPlan operations or as documented in company policies and procedures.
  • Maintain required levels of production and quality standards as established by management.
  • Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
  • Maintains regular and consistent attendance.
  • Adheres to Compliance Plan and HIPAA regulations.

MARGINAL JOB FUNCTIONS:

  • Takes on special projects as needed.
  • Performs other duties as assigned.

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