Claims Examiner jobs in Vallejo, CA

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)

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Temporary Claims Examiner I
  • Partnership HealthPlan of California
  • Fairfield, CA TEMPORARY
  • Overview

    To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters. Routes and tracks claims requiring review by other staff and departments, and processes when possible.

    Responsibilities

    • Reviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims within established production and quality standards. Completes claims from the Batch Error Report and Batch Pass Report.
    • Routes claims to appropriate PHC departments and internal staff for additional review. Follows up and completes claims once response to request has been received.
    • Follows established PHC policies and procedures, PHC Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims.
    • Generates claims correspondence as needed.
    • Records daily production statistics and related activities on appropriate reports. Turns in all logs and reports to the Medi-Cal Claims Supervisor.
    • Reviews all work audits in a timely manner and submits any adjustments and corrections within the allotted time frame.
    • Supports Claims Department’s needs for resolving all pended claim types.
    • Participates in special projects and assignments as required.
    • Other duties as assigned.

    Qualifications

    Education and Experience

    High school diploma or equivalent; prior experience examining claims in an automated environment; or equivalent combination of education and experience.  

     

     

    Special Skills, Licenses and Certifications

    Effective written and oral communication skills. Good organization skills.

     

     

     

    Performance Based Competencies

    Ability to effectively exercise good judgement within scope of authority and handle sensitive issues with tact and diplomacy. Ability to stay focused on repetitive work and meet production and quality standards. Ability to accurately complete tasks within established timelines.

     

     

     

    Work Environment And Physical Demands

    Ability to use a computer keyboard. More than 80% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 5 lbs.

     

     

     

     

    All HealthPlan employees are expected to:

     

    • Provide the highest possible level of service to clients;
    • Promote teamwork and cooperative effort among employees;
    • Maintain safe practices; and
    • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

    HIRING RANGE:

     

    $22.00/hour

     

    IMPORTANT DISCLAIMER NOTICE

     

    The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

  • 18 Days Ago

P
Claims Examiner II
  • Partnership HealthPlan of California
  • Fairfield, CA FULL_TIME
  • Overview To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Completes and processes claims and claim...
  • 1 Month Ago

P
Claims Examiner I
  • Partnership HealthPlan of California
  • Fairfield, CA FULL_TIME
  • Overview To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Creates appropriate documentation that r...
  • 1 Month Ago

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Claims Examiner III - Hybrid / Remote
  • Tristar Insurance
  • Concord, CA OTHER
  • Job Details Level: Experienced Job Location: Concord Office - Concord, CA Position Type: Full Time Education Level: High School Diploma or GED Salary Range: $90,000.00 - $95,000.00 Salary/year Travel ...
  • 4 Days Ago

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Mobile Phlebotomist/Paramedical Examiner
  • ExamOne, A Quest Diagnostics Company
  • Hercules, CA PART_TIME
  • Medically trained Mobile Phlebotomist/Collector:As a Mobile Collector, you would be a part-time, on-call, and at-will employee.What does this mean?On-Call and At-Will equal Flexibility! You will choos...
  • 21 Days Ago

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Claims Coordinator
  • ServiceMaster Cleaning and Restoration by Levi 9327
  • American Canyon, CA FULL_TIME
  • Position Overview As the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field perso...
  • 11 Days Ago

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0 Claims Examiner jobs found in Vallejo, CA area

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Claims Examiner
  • JT2 Integrated Resources
  • Oakland, CA
  • JT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients whi...
  • 4/26/2024 12:00:00 AM

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Senior Claims Examiner
  • Berkley
  • Walnut Creek, CA
  • Company Details: Berkley Enterprise Risk Solutions will offer specialized workers compensation solutions to California-b...
  • 4/26/2024 12:00:00 AM

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Workers Compensation Claims Examiner | Concord, CA
  • Sedgwick
  • Concord, CA
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A c...
  • 4/26/2024 12:00:00 AM

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Territory Manager | California-East Bay/North Bay, Alaska and Hawaii
  • Employers Holdings, Inc.
  • San Francisco, CA
  • TERRITORY MANAGER I California - EastBay/NorthBay, Alaska & Hawaii Preference given to candidates with P&C carrier sales...
  • 4/26/2024 12:00:00 AM

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Insurance Agent
  • Bankers Life
  • Pleasanton, CA
  • Bankers Life® is searching for future agents to work in a fast-paced and dynamic hybrid remote environment. Jumpstart yo...
  • 4/26/2024 12:00:00 AM

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Territory Manager | California- San Francisco -East Bay/North Bay, Alaska and Hawaii
  • EMPLOYERS
  • San Francisco, CA
  • TERRITORY MANAGER I San Francisco -East Bay/North Bay, Alaska and Hawaii Preference given to candidates with P&C carrier...
  • 4/24/2024 12:00:00 AM

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Insurance Agent
  • Kevin Daniel Insurance Agency LLC
  • Napa, CA
  • Job Description Job Description Are you ready to make $100,000+ this year? I am seeking a Licensed Insurance Agent who h...
  • 4/22/2024 12:00:00 AM

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Workers Compensation Claims Examiner | Concord, CA (Hybrid)
  • Sedgwick
  • Concord, CA
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A c...
  • 4/22/2024 12:00:00 AM

Vallejo (/vəˈleɪ(h)oʊ/ və-LAY-(h)oh; Spanish: [baˈʎexo]) is a waterfront city in Solano County, California, located in the North Bay subregion of the San Francisco Bay Area. Vallejo is geographically the closest North Bay city to the inner East Bay, so it is sometimes associated with that region. Its population was 115,942 at the 2010 census. It is the tenth most populous city in the San Francisco Bay Area, and the largest in Solano County. Vallejo sits on the northeastern shore of San Pablo Bay, 30 miles north of San Francisco, the northwestern shore of the Carquinez Strait and the southern e...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner jobs
$53,846 to $71,402
Vallejo, California area prices
were up 2.5% from a year ago