Claims Examiner, Sr. jobs in San Bernardino, CA
Claims Examiner, Sr. reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner, Sr. 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, Sr. determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner, Sr. occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Claims Examiner, Sr. typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Claims Examiner, Sr. jobs
Claims Examiner II (PD)
- Desert Oasis Healthcare
-
Palm Desert, CA
FULL_TIME
-
To process for payment all encounters, ancillary, hospital, tertiary and specialist claims according to contract.
- Adjudicate claims in accordance with Managed Care Operations and CMS and DMHC guidelines.
- Follow the eligibility research protocol including verifying member benefits and COB.
- Review authorization status codes and notes affecting the adjudication of the claim.
- Submits claims to UM per protocol.
- Complete all required fields and keying appropriate CPT& DX codes and scan appropriate documents with claim.
- Apply provider contract rates appropriately based on effective dates and amendment updates.
- Process claims according to applicable Health Plan Division of Financial Responsibility matrix.
- Assist management with audit process.
- Research and resolve customer service issues in a timely manner to ensure quality claims service.
- Meet productivity and error ratio standard as required.
- Apply payment rules regarding modifier and CPT code guidelines.
- Perform all daily self audit reports.
- Process payment adjustments and refund requests per protocol.
- Process high dollar surgical and in patient facility claims requiring Case Note Review.
- Reconcile Health Plan error reports as required and accept all other special projects as assigned.
- High School diploma or equivalent (GED).
- 3 to 5 years experience in a healthcare environment. Minimum of 1 year of Claims experience.
- Knowledge of Medicare rules, medical terminology, and managed care health plan rules and regulations, ICD-10, CPT and RVS codes.
- Strong computer skills. EZ-CAP and Excel skills preferred. 10 key calculator by touch.
- Strong organizational skills and the ability to work independently and under pressure.
- Interacts and communicates effectively.
- No driving required.
- At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.
- 10 Days Ago
Plans Examiner
- City of Hesperia
-
Hesperia, CA
FULL_TIME
- ** Final Filing Date: Friday May 17, 2024 @ 4:30 PM** About this Position: The City of Hesperia is looking to fill our Plans Examiner vacancy. Under general supervision, the Plans Examiner performs in...
- Just Posted
Polygraph Examiner-Extra-Help
- San Bernardino County
-
San Bernardino, CA
TEMPORARY
- The County of San Bernardino Sheriff's Department is recruiting for Extra-Help Polygraph Examiners who administer polygraph examinations for the Specialized Investigations Division. Responsibilities i...
- 20 Days Ago
Plans Examiner II
- City of San Bernardino
-
San Bernardino, CA
FULL_TIME
- Are you looking for an opportunity for professional growth and development? Consider joining the City of San Bernardino's Community and Economic Development Department as a Plans Examiner II. About th...
- 21 Days Ago
Mobile Phlebotomist/Paramedical Examiner
- ExamOne, a Quest Diagnostics company
-
Hesperia, 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...
- 12 Days Ago
Fire Plans Examiner
- County of San Bernardino
-
San Bernardino, CA
FULL_TIME
- Applications will be accepted until a sufficient number of applications are received. Excellent Benefits Package includes retirement, health, vacation, & much more! The San Bernardino County Fire Prot...
- 24 Days Ago
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0 Claims Examiner, Sr. jobs found in San Bernardino, CA area
Claims Adjuster Senior Workers Compensation
- Gallagherbassett
-
Rancho Cucamonga, CA
- ** Claims Adjuster Senior Workers Compensation** **** New Gallagher Bassett is the premier provider of global claims ser...
- 4/24/2024 12:00:00 AM
Claims Adjuster Trainee - Auto, I, II, Sr
- Direct Auto
-
Ontario, CA
- Location: Location: Claims Adjuster Trainee - Auto, I, II, Sr in Ontario, CA at Direct Auto Insurance **Location:** **Ex...
- 4/24/2024 12:00:00 AM
Claims Service Representative II
- Wawanesa Mutual Insurance Company
-
San Bernardino, CA
- **Claims Service Representative II** **Location:** San Diego, CA, US, 92108 Fort Collins, CO, US, 80526 Sacramento, CA, ...
- 4/23/2024 12:00:00 AM
Senior Auto Claims Examiner | Remote
- King's Insurance Staffing
-
Irvine, CA
- Our client has been experiencing continued growth and seeking to add a Senior Auto Liability/Bodily Injury Claims Examin...
- 4/22/2024 12:00:00 AM
California Workers Compensation Claims Specialist Opportunities!
- Crawford & Company
-
Brea, CA
- Excellence In Everything We TouchWe are always searching for Workers Compensation Claim Examiners in the California regi...
- 4/22/2024 12:00:00 AM
Claims Examiner -Remote
- Generis Tek Inc
-
Irvine, CA
- Please Contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Abhinav Chakraborty ...
- 4/20/2024 12:00:00 AM
California Workers Compensation Claims Specialist Opportunities!
- Crawford & Company
-
Brea, CA
- Excellence In Everything We Touch We are always searching for Workers Compensation Claim Examiners in the California reg...
- 4/20/2024 12:00:00 AM
Senior Property Field Adjuster
- Automobile Club of Southern California
-
Riverside, CA
- Senior Property Field Adjuster This position handles highly complex homeowner claims matters involving material damage, ...
- 1/9/2024 12:00:00 AM
About San Bernardino, California
According to the United States Census Bureau, the city has a total area of 59.6 square miles (154 km2), of which 59.2 square miles (153 km2) is land and 0.4 square miles (1.0 km2), or 0.74%, is water.
The city lies in the San Bernardino foothills and the eastern portion of the San Bernardino Valley, roughly 60 miles (97 km) east of Los Angeles. Some major geographical features of the city include the San Bernardino Mountains and the San Bernardino National Forest, in which the city's northernmost neighborhood, Arrowhead Springs, is located; the Cajon Pass adjacent to the northwest border; City...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner, Sr. jobs
$65,782 to $84,811
San Bernardino, California area prices
were up 3.0% from a year ago
were up 3.0% from a year ago
What does a Claims Examiner, Sr. do?
Claims Examiner, Sr. in Riverside, CA
Health Claims Examiners, or Health Information Technicians, enter data electronically to process transactions.
December 14, 2019
Claims Examiner, Sr. in Evansville, IN
If you’re in dire straits, we can advise you on steps to get the OWCP claims examiner to pay attention to your needs, such as contacting the Department of Labor’s district director, or the national director via mail.
February 12, 2020
Claims Examiner, Sr. in Springfield, IL
No, the examiner is only involved in performing the exam and providing the results to the claims processor.
January 13, 2020