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Job 25749


Location:
San Diego, CA

Job Title:
Claims Processor (Clairemont Mesa)

Employment:
Long Term Temp (> 30 Days)

Description:

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.

Responsibilities:

  • 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

Basic Qualifications:

  • 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 Qualifications:

  • Preferred knowledge of Medi-cal Managed Care

 

On Call Staffing Solutions, Inc. is an Equal Opportunity Employer – Minority/Female/Disability/Veterans



Minimum Years of Experience:
2

Pay Rate:
15.78




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