Claims Examiner reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)
Description
The Position.
We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits based on established criteria and provider contracts. Experience in adjudication of Commercial, Medicare Advantage, and Medi-Cal claims will make you a great candidate, along with experience or familiarity with Healthcare Service industry, Independent Physician Associates (IPAs), and/or have experience in a Managed Care/Service Organization (MSO) or Health Plan background.
The Specs.
The Duties.
*Please note that the duties and responsibilities outlined above are summarized and may not encompass all tasks associated with the position. The nature of the role may require adaptation to changing circumstances and additional responsibilities not explicitly mentioned here. The organization reserves the right to modify, interpret, or supplement the job duties as needed.
THE COMPANY.
Innovative Management Systems is a management services company focused on finding innovative ways to ensure regulatory compliance, customer services, provider experience, and measurable outcomes in the healthcare industry. Through our ever-evolving data analytics platform, we strive to improve overall medical spending, HEDIS, and STAR measures through a collaborative effort of education, reporting and workflow management. Come be part of the team that helps to improve quality of care, reduce administrative burden, and achieve greatness through creative thinking and educated calculated risks. Be the change in healthcare everyone talks about, but few people achieve. We value our team’s opinions and new ways of getting the job done and are looking for self-starters with fresh ideas, ready to help pave the way to a better tomorrow.
We are an Equal Opportunity Employer and seek diversity in our workforce. We are also an E-Verify Employer, you can learn more about E-Verify program and your rights and responsibilities here: Learn More About E-Verify.
Requirements
What You Need.
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0 Claims Examiner jobs found in Los Angeles, CA area