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Medical Claims Examiner

2 months 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, UB-04, and high dollar claims
  • Process JAA / BlueCard claims and interpret individual group SPD's and apply benefits appropriately
  • Zero dollar adjustments and maintain Provider Assignment, COB, Medi-Cal, CAS Status 8 reports
  • Review/create/process FOGBUGZ cases and access Anthem Blue Cross website for inquiries and JAA / BlueCard claims processing
  • Batch/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 & vision
  • Critical Illness, Accident, and Hospital
  • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
  • Life Insurance (Voluntary Life & AD&D for the employee and dependents)
  • Short and long-term disability
  • Health Spending Account (HSA)
  • Transportation benefits
  • Employee Assistance Program
  • Time Off/Leave (PTO, Vacation or Sick Leave)