Current jobs related to Claims Assessment Specialist - Industry, California - Innovative Management Systems Incorporated

Position Overview:

We are seeking a meticulous professional who can effectively evaluate, investigate, and interpret insurance claims to ascertain and compute the appropriate type and level of benefits in accordance with established guidelines and provider agreements. A background in processing Commercial, Medicare Advantage, and Medi-Cal claims will position you as a strong candidate, along with familiarity or experience in the Healthcare Services sector, Independent Physician Associations (IPAs), or a Managed Care/Service Organization (MSO) or Health Plan environment.

Job Specifications:

• Full-Time Employment.
• Eligible for Benefits: Medical, Dental, Vision, Paid Time Off, and additional perks.
• Non-exempt Position.
• Standard Work Week: Monday to Friday.
• Emphasis on Work-Life Balance.

Key Responsibilities:

• Verifying authorizations and aligning them with claims.
• Addressing and resolving claims inquiries for both internal and external stakeholders.
• Processing claims within the appropriate financial categories.
• Identifying instances of dual coverage and potential third-party liability claims.
• Coordinating Benefits for management approval and updating system insurance coverage profiles.
• Comprehending and interpreting health plan financial responsibility divisions and contract language.
• Assisting the Claims Department and collaborating with other Examiners to troubleshoot claims issues for stakeholders.
• Documenting claim resolutions to support payment decisions.

* Please be aware that the responsibilities outlined above are a summary and may not encompass all tasks associated with the role. The nature of the position may require adaptation to evolving circumstances and additional responsibilities not explicitly mentioned here. The organization reserves the right to modify, interpret, or supplement job duties as necessary.

About the Company:

Innovative Management Systems is a management services organization dedicated to discovering innovative solutions to ensure regulatory compliance, enhance customer service, improve provider experiences, and achieve measurable outcomes within the healthcare sector. Through our continually advancing data analytics platform, we aim to optimize overall medical expenditures, HEDIS, and STAR measures through a collaborative approach involving education, reporting, and workflow management. Join our team to contribute to enhancing care quality, minimizing administrative burdens, and achieving excellence through innovative thinking and informed risk-taking. Be part of the transformation in healthcare that many discuss but few accomplish. We value our team's insights and fresh perspectives and are in search of self-motivated individuals ready to help shape a better future.

We are an Equal Opportunity Employer and actively seek diversity within our workforce. We are also an E-Verify Employer .

Qualifications:

• High School Diploma or equivalent experience in managed care/services, health plans, and/or IPA.
• At least 1 year of relevant claims processing experience in managed care/services, health plans, and/or IPA (preferred).
• Proficient knowledge of HCFA 1500 forms, CPT, and ICD codes (required).
• Strong grasp of financial responsibility divisions for risk determination.
• Practical understanding of applicable business practices and relevant regulations/policies.
• Excellent written and verbal communication skills.
• Strong knowledge of contract language and claims processing software.
• Ability to sit for extended periods.
• Professional demeanor, sound business judgment, and strong collaborative skills.
• Valid Driver's License or reliable commuting capability.
• U.S. Work Authorization (required).

Compensation Information: $20-24 Hourly Wage

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