Medical Claims Examiner

Job DescriptionJob Description Summary:Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge of medical terminology necessary. Strong knowledge of Commercial, Medicare and Medi-Cal codes. Basic PC knowledge with...

Job Title: Workers Compensation Claims Examiner 6 month Contract $45hr Location: Onsite preferred, Remote (within CA) or Hybrid consideredPRIMARY PURPOSE: Analyze mid- and higher-level workers' compensation claims to determine benefits due, ensure ongoing adjudication within company standards and industry best practices, and identify subrogation...

Job DescriptionJob DescriptionThe claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospital Client. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is...

Salary Range: $55, Min.) - $69, Mid.) - $75, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...

Required Skills & ExperienceExtensive knowledge of medical terminology, ICD9, ICD10, and CPT codes.Extensive knowledge of Plan benefits, group insurance, and Medicare principals.Knowledge of Coordination of Benefits rules.Considerable knowledge of basic math.Ability to maintain production standards in a detail‐oriented, quality‐conscious service...

Required Skills & Experience Extensive knowledge of medical terminology, ICD9, ICD10, and CPT codes. Extensive knowledge of Plan benefits, group insurance, and Medicare principals. Knowledge of Coordination of Benefits rules. Considerable knowledge of basic math. Ability to maintain production standards in a detail‐oriented, quality‐conscious service...

Salary Range:  $55,245.00 (Min.) - $69,045.00 (Mid.) - $75,955.00 (Max.)   Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...

Overview of the Role: The Claims Auditor is responsible for reviewing claims processed by examiners based on provider and health plan contractual agreements and claims processing guidelines. Follows all internal processes and procedures to ensure claims audit activities are handled in accordance with departmental and company policies and procedures....

Job Description This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHS. This position includes the responsibility for routine hospital and professional audits, complex audits on individual or...

Handle OTAI claims including complex cases and coordinate other OTAI related matters, and undertake special projects as assigned by Manager. Essential Job Functions:Receive notice of OTAI claims in Japanese and English from policyholders, insureds, m Examiner, AI, Claims, Technology, Insurance

Press Tab to Move to Skip to Content Link Select how often (in days) to receive an alert: Manager, Claims Job Category: Claims Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11073 Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established...

Job Summary The Manager, Claims directs the efforts of others in the achievement of the strategic, regulatory and operational objectives of the Health Plan. Provides direct supervision to a team of claims examiners, data entry clerks and claims assistants and continuously monitors department for compliance with regulatory requirements. Ensures all work...

Salary Range: $102, Min.) - $132, Mid.) - $163, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...

Job DescriptionJob DescriptionSummary:As a Provider Dispute Resolution Examiner, you will be responsible for handling the provider dispute resolution process, resolving disputes in a timely and fair manner, and maintaining accurate records of disputes and their resolution. You will collaborate with providers, internal teams, and external stakeholders to...

POSITION TITLE Claims Review Coordinator REPORTS TO Assistant Manager, Claims & Appeals JOB SUMMARY The Claims Review Coordinator is responsible for the investigation, documentation and resolution of denied claims in compliance with State/Federal law, rules, and guidelines. The Claims Review Coordinator will perform research and utilize extensive claims...

Salary Range:  $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)   Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2...

Description Take on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health. The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned to the...

Required: Ability to operate PC-based software programs or automated database management systems. Strong communication skills with excellent analytical and problem solving skills. Ability to self-manage in a fast-paced, detail-oriented environment. Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to...

Job DescriptionJob DescriptionSummaryResponsible for accurate review and input of claims in accordance with outside regulation, internal production standards and contractual obligations of the organization. Duties and Responsibilities1. Accurately review all incoming claims to verify if required fields are populated.2. Process claims information into the...

General Information Press space or enter keys to toggle section visibility Work Location: Los Angeles, USA Onsite or Remote Flexible Hybrid Work Schedule Monday - Friday, 7:00am - 3:30pm PST Posted Date 01/30/2024 Salary Range: $24.28 - 48.04 Hourly Employment Type 2 - Staff: Career Duration indefinite Job # 9046 Primary Duties and Responsibilities Press...