A large healthcare organization in San Diego seeks a Claims Processor! The primary purpose of this Claims Processor II position is to examine and process claims from the UB04 and CMS-1500 claim forms into the claims adjudication system for all capitated and shared services accounts. This position is responsible for the accurate review, input and adjudication of claims using reasonable payment policies and methodologies that are consistent with and recognized by Health Plans, nationally recognized medical organizations, federal regulatory bodies, and contractual obligations of the organization.
Provide expertise and/or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims.
Authorize appropriate payment or refer claims for further investigation as appropriate.
Analyze and identify trends
Consistently meet established productivity schedule, adherence, and quality standards
Process priority and special claims requests
Process claims adjustments and/or appeals
High School diploma, GED or foreign equivalent
Must have 2 years' working experience in a medical claims role
Working experience and knowledge of examining, and process claims from the UB04 and CMS-1500 claim forms into the claims adjudication system for all capitated and shared services accounts
Able to work in a call center environment
Preferred knowledge of Medi-cal Managed Care
On Call Staffing Solutions, Inc. is an Equal Opportunity Employer – Minority/Female/Disability/Veterans