Sr. Claims Examiner, FT Days
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Job Location:
Whittier, CA - USA
Monthly Salary:
USD 21 - 33
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
The Senior Claims Examiner administers health plan contracts by processing medical claims in an efficient cost-effective and timely manner meeting all required guidelines and performs adjustments as necessary. Some of the duties include handling of Third-Party Liability requests Out-of-pocket Maximum requests EDI rejects and other special projects.
PIH Health is a nonprofit regional healthcare network that serves approximately 3 million residents in the Los Angeles County Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital PIH Health Good Samaritan Hospital PIH Health Whittier Hospital 37 outpatient medical office buildings a multispecialty medical (physician) group home healthcare services and hospice care as well as heart cancer digestive health orthopedics womens health urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nations top hospital systems for best practices cutting-edge advancements quality of care and healthcare technology. For more information visit or follow us on Facebook Twitter or Instagram.
Required Skills
- Computer and 10-key skills by touch;
- Knowledge of medical terminology CPT/RBRVS/ICD-9 codes;
- Full understanding of HMO & capitation concepts and Medicare guidelines;
- Excellent communication skills;
- Ability to work independently and function under time deadlines.
Required Experience:
Senior IC
Key Skills
- Auditing
- GAAP
- Military Experience
- Phlebotomy
- Conflict Management
- Vital Signs Experience
- Computer Forensics
- Research Experience
- Securities Law
- Operating Systems
- PTSD Care
- RMF
