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Claims Review and Resolution Expert

2 months ago

French Camp, California, United States SAN JOAQUIN COUNTY HEALTH COMMISSION Full time
Job Overview

Position: Claims Auditor

Company: SAN JOAQUIN COUNTY HEALTH COMMISSION

Under general oversight, this role involves the examination of claims data and adjustments to ensure precision in input and adjudication, while facilitating the processing of designated claims.

  • Conducts thorough reviews of various documents such as claims, appeals, refunds, and correspondence.
  • Identifies and evaluates discrepancies to ascertain their origins.
  • Records findings and communicates them for necessary corrections and adjudication.
  • Offers constructive feedback, submits reports, and monitors potential significant loss claims.
  • Engages with both internal and external stakeholders to address inquiries and requests.

Location: Remote, must reside in California

Qualifications:

Knowledge, Skills, and Abilities:

Required:

  • Comprehensive understanding of Medi-Cal regulations pertinent to claims processing.
  • Familiarity with procedural coding, medical terminology, and healthcare policy benefits.
  • Excellent communication and interpersonal skills.
  • Capability to work autonomously as well as collaboratively within a team.
  • Proficiency in data analysis and reporting tools.
  • Strong organizational and prioritization abilities.
  • Basic arithmetic skills and proficiency in Windows, Excel, Word, and Outlook.

Preferred:

  • Knowledge of auditing processes and reinsurance.

Experience and Education:

Required:

  • High school diploma with a minimum of three years' experience as an Analyst II or equivalent.

Preferred:

  • Associate's Degree with experience in claims auditing.

Certification:

  • Preferred: Certification in medical coding or auditing.

Benefits:

  • Competitive salary structure.
  • Comprehensive health, dental, and vision coverage.
  • Generous paid time off and retirement plans.
  • Flexible spending accounts and various insurance options.
  • Opportunities for training and professional development.
  • A mission-driven organization focused on community wellness.
  • A diverse and inclusive workplace environment.

Company Vision:

To continuously enhance the health of the community.

Company Mission:

To deliver healthcare value and promote wellness through community partnerships.