Medical Claims Examiner

5 days ago


Fresno, California, United States TEKsystems Full time
Job Summary

We are seeking a highly skilled Medical Claims Examiner to join our team at TEKsystems. As a Medical Claims Examiner, you will be responsible for processing medical claims in a computerized environment, ensuring accurate and timely processing of claims.

Key Responsibilities
  • Maintain multiple groups and process CMS-1500 and UB-04 claims
  • Process high-dollar claims and JAA/BlueCard claims
  • Interpret individual group SPDs and apply benefits appropriately
  • Zero-dollar adjustments and maintain provider assignment, COB, Medi-Cal, and CAS status reports
  • Review and process FOGBUGZ cases and access Anthem Blue Cross website for inquiries and JAA/BlueCard claims processing
  • Batch and scan correspondence and access WIKI for policies and procedures
  • Maintain confidentiality of sensitive information and effective communication with team members and managers
  • Maintain claim inventory turnaround time and volume within acceptable levels
Requirements
  • High School Diploma/GED equivalent required; Associates or Bachelor's Degree in Business or related medical field preferred
  • Previous experience in a lead or lead-type position preferred; minimum of 3 years of experience processing medical claims in a computerized environment
Benefits
  • Medical, dental, and vision insurance
  • Critical Illness, Accident, and Hospital insurance
  • 401(k) Retirement Plan with pre-tax and Roth post-tax contributions available
  • Life Insurance (Voluntary Life & AD&D for the employee and dependents)
  • Short and long-term disability insurance
  • Health Spending Account (HSA)
  • Transportation benefits
  • Employee Assistance Program
  • Time Off/Leave (PTO, Vacation, or Sick Leave)


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