HMO Claims Examiner - Claims Processing - Position #2019-444

HMO CLAIMS EXAMINER - CLAIMS PROCESSING - Position #2019-444

Date Posted:
Classification:
Administrative
Type
Full Time
Location
OPEN UNTIL FILLED - Redlands - Monday - Friday - 6:00a.m. - 2:30p.m.

Job Description

The HMO Claims Examiner administers HMO contracts by processing medical claims in an efficient, cost-effective, and timely manner.  Responsible for determining financial responsibility between group, health plans and contracted hospitals for accurate processing of claims. The HMO Claims Examiner is supervised directly by the Claims Manager and has regular interaction with patient insurance providers, and other department and interdepartmental staff.

 

Qualifications

High School Diploma or equivalent. Course work and knowledge of medical terminology preferred. One year of claims adjudication or claims data entry processing experience in a Managed Care/IPA environment. Two years of experience preferred.  Knowledge of ICD9 and CPT/RVS codes required; clerical ability necessary, including ten-key calculator, computer, and light typing skills 35wpm. Ability to multi-task in an efficient, thorough, and prioritized manner; to work quickly, accurately and independently; and, to anticipate needs and solve problems.            

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