HMO CLAIMS EXAMINER - CLAIMS PROCESSING - Position #2019-444
- Date Posted:
- Full Time
- OPEN UNTIL FILLED - Redlands - Monday - Friday - 6:00a.m. - 2:30p.m.
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.
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.