Entry Level Claims Examiner & Customer Service (Medical) Job Vacancy in Local 1014 El Monte, CA 91731 – Latest Jobs in El Monte, CA 91731
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Company Name : Local 1014
Location : El Monte, CA 91731
Position : Entry Level Claims Examiner & Customer Service (Medical)
Job Description : Local 1014, the self-funded ERISA Trust dedicated to serving the wellbeing of the LA County Fire Fighters and their families. We are seeking an Entry-Level Claims Examiner and Customer Service Representative. The ideal candidate should have great attention to detail around reviewing medical claims, and a great ability to provide excellent customer service to a wide customer base. Highly effective communication and writing correspondence will be highly important. NOTE: Benefits for this position, if chosen to be permanent, are top in the industry.Position Overview: Responsible for reviewing physician and ancillary provider claims accurately based on medical authorization and apply all applicable coding edits, contractual agreements, and Plan provisions. Provide back-up support to Member Services, fielding incoming telephone calls from members and providers to provide answers and resources to questions.Position reports to: Claims ManagerEssential Job Functions: Process paper and electronic physician and ancillary provider claim submissions as appropriate (pay, deny, pend)Maintain working knowledge of the Plan and effectively apply that knowledge, including covered expenses, exclusions, coordination of benefits, and coordination with MedicareReview all claims for potential fraud, waste and abuseIdentify claims with Workers’ Compensation or Third Party Liability potential and refer to the appropriate area for further investigationIdentify claims requiring clinical review, obtain appropriate medical records, and refer to Claims Manager for reviewInterface with members and providers; periodically follow-up on pended claims; completion of error corrections; and adjustment of claims as necessaryFunction as a member services representative when necessary as requested by Claims ManagerConsistently meet established productivity, schedule adherence, and quality standardsAdhere to internal policies and proceduresOther duties as assigned by the Claims Manager.Required Knowledge/Skills/Abilities/ExperienceHigh School diploma/GED and two years of recent experience as a health claims examiner processing Group Medical claims, or equivalent education/experience such as healthcare benefits, benefit administration or health care delivery from either a payer or provider perspective.Working knowledge of medical terminology, physician billing practices, CPT coding, ICD-9/ICD-10 coding, and CPCS coding.HHCPCS coding.Working knowledge of the Plan in terms of covered expenses and exclusions, coordination of benefits and third-party liability provisions.Strong analytical ability and problem resolution skills.Excellent typing and 10-key skills.Ability to work under pressure and adapt to changing environments.Familiarity with computer and Windows PC applications; ability to learn new and complex computer system applications, and to navigate between various computer applications/systems to conduct research and to respond to members and providers.Ability to communicate clearly and professionally, both verbally and in writing.Solid organizational skills with strong attention to detail and listening skills.Possess a strong work ethic and team player mentality.Amazing Compensation & Benefits Package (benefits start day 1)$110k – $119k (annually)100% covered benefits for employee AND dependentsRetirement contribution matching up to 8.3%13 holidays, 2 weeks vacation, 12 sick daysMon – Fri flexible schedule (no holidays, weekends or overnight)Eligibility for partial remote schedule after 6 months of successful trainingPlease submit a Resume AND answer all questions for consideration!!!Job Type: Full-timePay: $25.00 – $28.00 per hourBenefits:401(k)401(k) matchingDental insuranceHealth insurancePaid time offVision insuranceSchedule:8 hour shiftMonday to FridayApplication Question(s):Are you currently, or was your previous position (if unemployed) in a claims processing role?Experience:Group Medical Claims Processing: 2 years (Preferred)Worker’s Compensation Claims: 2 years (Preferred)ICD Coding: 2 years (Preferred)HCPCS Coding: 2 years (Preferred)HHCPCS: 2 years (Preferred)Medical Terminology: 2 years (Preferred)Processing Anthem/Blue Cross Claims: 1 year (Preferred)Work Location: One location
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