Claims Examiner

POSITION SUMMARY: The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.

EDUCATION/EXPERIENCE/TRAINING: • High school graduate or equivalent required. Must have physical proof on hand if background check is unable to verify your education background. • Minimum of 2 years claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environment • Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services * Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims * Knowledge of compliance issues as they relate to claims processing • Experience in interpreting provider contract reimbursement terms desirable • Ability to identify non-contracted providers for Letter of Agreement consideration • Data entry experience • Training on basic office automation and managed care computer systems

Must Have: Must have listed claims reimbursement experience Must have DOFR Must have processed lab claims

salary: $22.99 - $23 per hour
shift: First
work hours: 7 AM - 3:30 PM
education: High School

Responsibilities

• Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
* Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims
* Knowledge of compliance issues as they relate to claims processing
• Experience in interpreting provider contract reimbursement terms desirable
• Ability to identify non-contracted providers for Letter of Agreement consideration
• Data entry experience

Skills

• claims examin
• processing functions
• payment methodologies

Qualifications

• Years of experience: 0 years
• Experience level: Experienced

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.


Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.


We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.