Current jobs related to Claims Examiner III - Orange - Prospect Medical Holdings
-
Claims Examiner
1 day ago
Orange, California, United States Cynet Systems Full timeJob Title: Claims ExaminerJob Summary:Cynet Systems is seeking a skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for analyzing and processing complex workers' compensation claims, investigating and gathering information to determine exposure, and managing claims through well-developed action plans to achieve timely and...
-
Medical Claims Examiner
2 weeks ago
Orange, California, United States Prospect Medical Holdings Full timeJob Title: Medical Claims ExaminerAt Prospect Medical Holdings, we are seeking a highly skilled Medical Claims Examiner to join our team. As a Medical Claims Examiner, you will play a critical role in ensuring the accuracy and timeliness of claims processing.Responsibilities:Apply claim processing experience to audit and analyze all levels of claims...
-
Workers Compensation Claims Examiner
1 week ago
Orange, California, United States Sedgwick Claims Management Services Full timeJob SummaryWe are seeking a skilled Workers Compensation Claims Associate to join our team at Sedgwick Claims Management Services.Key ResponsibilitiesAnalyze reported lower-level workers compensation claims to determine benefits due.Ensure ongoing adjudication of claims within company standards and industry best practices.Adjust medical-only workers...
-
Workers Compensation Claims Examiner
3 days ago
Orange, California, United States Sedgwick Full timeAbout the RoleSedgwick is seeking a skilled Workers Compensation Claims Examiner to join our team. As a Claims Examiner, you will play a critical role in analyzing and processing workers' compensation claims to ensure timely and fair resolutions for our clients.Key ResponsibilitiesAnalyze and process claims through well-developed action plans to achieve...
-
Claims Examiner
3 weeks ago
Orange, California, United States BCForward Full timeJob OpportunityWe are seeking a highly motivated Claims Examiner - Workers Compensation to join our team at BCForward.Job Summary:As a Claims Examiner - Workers Compensation, you will be responsible for examining and processing workers' compensation claims in a timely and efficient manner. You will work closely with our clients to understand their needs and...
-
Claims Examiner
2 weeks ago
Orange, United States BCForward Full timeJob DescriptionJob Description BCforward is currently seeking a highly motivated Claims Examiner - Workers Compensation for an opportunity in Orange, CA!Job DescriptionPosition Title: Claims Examiner - Workers CompensationLocation: Orange,CAAnticipated Start Date: July 29, 2024Please note this is the target date and is subject to change. BCforward will...
-
Claims Examiner
9 hours ago
Orange, California, United States BCforward Full timeJob Title: Claims ExaminerWe are seeking a highly motivated Claims Examiner to join our team at BCforward. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims, determining benefits due, and managing high-exposure claims involving litigation and rehabilitation.Key Responsibilities:Analyze and process complex...
-
Orange, California, United States Sedgwick Full timeJob SummarySedgwick is seeking a skilled Claims Examiner Workers Compensation to join our team. As a Claims Examiner Workers Compensation, you will play a critical role in analyzing complex workers' compensation claims and determining benefits due. Your expertise will be essential in managing claims through well-developed action plans to achieve timely and...
-
Claims Examiner
1 week ago
Orange, United States Synectics Inc Full timeJob DescriptionJob DescriptionDescription: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...
-
Claims Examiner Workers Compensation Specialist
20 hours ago
Orange, California, United States Sedgwick Full timeJob SummarySedgwick is seeking a skilled Claims Examiner Workers Compensation to join our team. As a Claims Examiner Workers Compensation, you will play a critical role in analyzing complex workers' compensation claims and determining benefits due. Your expertise will be essential in managing claims through well-developed action plans to achieve timely and...
-
Claims Examiner
2 weeks ago
Orange, United States BCForward Full timeJob DescriptionJob DescriptionBCforward is currently seeking a highly motivated Claims Examiner - Workers Compensationfor an opportunity in Orange, CA.Position Title: Claims Examiner - Workers CompensationLocation: Orange, CA Anticipated Start Date: ASAPPlease note this is the target date and is subject to change. BCforward will send official notice ahead of...
-
Claims Review Specialist
4 weeks ago
Orange, California, United States Astiva Health, Inc Full timeJob Title: Claims Auditor/RecoveryTarget Compensation Range: $90,000 - $120,000/year, depending on the level of relevant qualifications and experience.About Us:Astiva Health, Inc. is a leading healthcare organization focused on Medicare and HMO services. We are dedicated to providing comprehensive care that meets the diverse needs of our community,...
-
Claims Auditor/Recovery Specialist
13 hours ago
Orange, California, United States Astiva Health, Inc Full timeJob Title: Claims Auditor/RecoveryAstiva Health, Inc. is seeking a skilled Claims Auditor/Recovery to join our team in Orange, CA. As a Claims Auditor/Recovery, you will be responsible for ensuring claims are processed in accordance with P&P and Medicare Guidelines.Key Responsibilities:Ensure claims are processed accurately and efficiently.Provide support to...
-
Indemnity Claims Specialist
4 weeks ago
Orange, California, United States Experis Full timeJob Title:Indemnity Claims SpecialistLocation:Remote position available for candidates located in CaliforniaContract Duration:4+ months on W2Pay Rate:$38 per hour_________________________________________________________Primary Purpose:Evaluate mid- to advanced-level indemnity claims, ascertain entitlements, and ensure continuous adjudication in alignment...
-
Claims Research Quality Analyst
3 weeks ago
Orange, United States Elite Workforce Full timeJob DescriptionJob DescriptionThe Claims Research Quality Analyst will be responsible to ensure that Daily, Weekly, Monthly and Quarterly Claims Reports are submitted accurately and in a timely manner, while also being responsible for analyzing reports and identifying process improvements.Please note that while this position is being advertised through our...
-
Orange, California, United States Sedgwick Full timeAbout the RoleWe are seeking a skilled Claims Associate Workers Compensation to join our team at Sedgwick. As a Claims Associate Workers Compensation, you will play a critical role in analyzing reported lower-level workers compensation claims to determine benefits due and ensuring ongoing adjudication of claims within company standards and industry best...
-
Production Planner III
4 months ago
Port Orange, United States By Light Full timeOverview The Planner III plans, schedules and coordinates the flow of work and materials that initiates demand internally and externally to drive supply chain; and within or between departments, according to the production schedule. The Planner III is responsible for maintaining and reporting production schedules, which includes but is not limited to...
-
Workers Compensation Adjuster
1 month ago
Orange, United States Intercare Insurance Full time $76,000 - $95,000Job DescriptionJob DescriptionWorkers Compensation Adjuster III Summary:Reports directly to the unit Claims Supervisor and may be called upon to provide technical backup in the absence of the Claims Supervisor. In accordance with applicable statutes and in keeping with company rules, regulations, and established performance objectives, is responsible for...
-
Healthcare Representative
6 hours ago
Orange, United States WOTM - Partners Professional Full timeJob DescriptionJob DescriptionNOW HIRING BILINGUAL CUSTOMER SERVICE REPRESENTATIVES Pay:$23-25 hourlySchedule:Monday through Friday, 9am-5:30pmOverview:The bilingual customer service representative for a healthcare insurance role is responsible for assisting clients in both English and a second language, providing information on insurance policies, claims,...
-
Cash Posting Specialist
3 weeks ago
Orange, California, United States BMR Partners Inc. Full timeJob SummaryBMR Partners Inc. is seeking a highly skilled Cash Posting Clerk to join our team. As a Cash Posting Clerk, you will be responsible for assisting the Reimbursement Supervisor in all areas of Collections, Billing, and Cash application.Key ResponsibilitiesAccurate and Timely Cash Posting: Ensure the accurate and timely posting of all cash payments...
Claims Examiner III
3 months ago
Responsible for consistently and accurately adjudicating claims in accordance with policies, procedures and guidelines as outlined by the company policy. Process claims according to all CMS and DMHC guidelines. Review, research and process complex claims. Handle recalculation of claims due to incorrect claim payments or where additional information has been received. Investigate and complete open or pended claims. Meet production and quality standards.
Responsibilities
- Enter claims information from CMS 1500 (professional) and UB-04 (facility) claims into the IDX claims system. Process all level of claims including Professional, COB, surgery, skilled nursing, lab, Home Health, ER, hospital (in and outpatient), DME, Pharmacy and radiology claims by applying Prospect's policy and procedures and all claim payment criteria. Analyze complex claim issues and handle all adjustments for corrected claims or when additional information previously requested is received.
- Identify and pend claims that require referrals to all support areas (eligibility, Medical management etc) for evaluation or correction of data, tracking these claims to ensure that they are returned and resolved within regulatory guidelines.
- Achieve stringent quality goals of 98% administrative accuracy and 99% financial accuracy to contribute to achieving client performance expectations.
- Achieve stringent productivity goals of 80/10 claims per day/hr. Initiate recovery of overpaid claims. Also any other duties as requested.
Qualifications
Minimum Education: High school diploma or equivalent required.
Minimum Experience: Three to five (3-5) years prior medical claims processing experience required. Knowledge of general claims processing principles, CMS claims coding, and UB-04 claims coding, based on at least three to five (3-5) years experience in claims processing preferably in a managed care environment (IPA,MSO)
Req. Certification/Licensure: None.
About Us
With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.
