Claims Adjustment Specialist

Job TitleWork Location: Los Angeles, CA, USAWork Schedule Monday - Friday, 7:00am - 3:30pm PSTSalary Range: $32.42 - 64.51 HourlyEmployment Type 2 - Staff: Career Duration indefinitePrimary Duties And ResponsibilitiesKey ResponsibilitiesNote: This posted position is 2 of 4 positions available for hire. All applicants will apply through this requisition and if selected will be hired into one of the available positions. Salary Range: $ 31.51 - $ 62.64/hourJob QualificationsAll items below are:Bachelor's degree in healthcare administration, business, finance, or a related field, or equivalent experienceMinimum three years or more of experience in medical claims processing or claims adjustmentApplies knowledge of healthcare reimbursement and payment methodologiesInterprets benefit plans, provider contracts, and fee schedulesAnalyzes complex post paid claims and adjustment requestsApplies CMS and DMHC regulatory requirements to claims processingUtilizes claims systems and standard office applications effectivelyCommunicates claim outcomes clearly in written documentationPrioritizes and manages multiple claims within required turnaround timesApplies analytical judgment to identify payment discrepanciesSupports root cause analysis related to claims processing issuesMaintains production and quality standards in accordance with department policy