Claims Processor

Claims Processor for a company in Foothill Ranch that serves medical providers, clients and patients.

This is a Temporary to Hire opportunity, pay rate $20-23/hr, depending on experience. Full-time, Monday - Friday, 7:00 AM - 4:00 PM, with a 1 hour unpaid lunch. This is 100% ON-SITE position. Ideal candidate will be organized and detail-oriented. Position offers mentorship and advancement opportunities.

Essential Responsibilities:

• In the Claims Processor role, not only are you responsible for qualifying claims/bills for payment, you will also need to check for coverage and apply co-pay's deductible, and.check coinsurance
• You will need to create cases and assist with incoming calls, as well as working closely with other departments
• Import claims received into specified cases. Claims are received through EDI software system. Company uses Gotham Insurance, Aetna Insurance and United Insurance. 
• Review and verify personal information including names, addresses, ages, and other data when reviewing claim submissions.
• Review claims which may require direct network contact.
• Responsible for contributing to cost containment efforts by validating bills for services rendered, authenticity and reasonable and customary charges.
• Responsible for handling disputes, as well as processing corrected and reworked claims.
• Manager inboxes for Gotham Insurance, Aetna Insurance and United Insurance. 
• Adhere to company policies and local, state, and federal guidelines when facilitating claims processing.
• Other duties, as deemed necessary in the role as a claim’s processor.

Qualifications:

• High School diploma, GED, or equivalent to 1+ years of customer service experience OR experience in a medical office, health care Call Center or Office setting analyzing and solving customer problems.
• MUST HAVE prior work experience opening cases and qualifying claims/bills for payment, checking for coverage and applying co-pay's deductible, and.checking coinsurance
• MUST HAVE fluency in basic computer systems like Microsoft Office, and/or risk assessment software. 
• Should have some experience in fielding phone calls and emails in a high-volume setting such as in a customer service representative position.
• Must have strong critical thinking, problem-solving, decision-making, and communication skills.