Disability Claims Examiner jobs in Santa Ana, CA

Disability Claims Examiner reviews, evaluates and processes disability insurance claims according to procedure and practice. Examines claims material to ensure insurance coverage and validity. Being a Disability Claims Examiner has contact with agents, claimants, and policy holders. Typically requires a bachelor's degree or its equivalent. Additionally, Disability Claims Examiner typically reports to a supervisor/manager. To be a Disability Claims Examiner typically requires 0-2 years of related experience. Works on projects/matters of limited complexity in a support role. Work is closely managed. (Copyright 2024 Salary.com)

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Claims Examiner II
  • MemorialCare Medical Foundation
  • Fountain Valley, CA FULL_TIME
  • Claims Examiner II

    - (MEM007743)
    Description


    Title:
    Claims Examiner II

    Location: Fountain Valley

    Department: Claims

    Status: Full-Time

    Shift: Days (8hrs)

    Pay Range: $22.41/hr - $32.50/hr

    At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.


    Position Summary

    The Claims Examiner II accurately reviews, researches and analyzes professional, ancillary and institutional inpatient and outpatient claims.

    Essential Functions and Responsibilities of the Job

    • Knowledge of CPT/HCPC and ICD-9/ICD-10 codes and guidelines.
    • Comprehensive knowledge of DMHC and CMS guidelines to accurately adjudicate Commercial and Medicare Advantage claims.
    • Comprehensive knowledge of various fee schedules and CMS prices for outpatient/inpatient institutional, ancillary and professional claims, including, but not limited to Medicare fee schedules, DRG, APC, ASC, SNF-RUG.
    • Ability to identify and report processing inaccuracies that are related to system configuration.
    • Process all types of claims, such as, HCFA 1500, outpatient/inpatient UB92, high dollar claims, COB and DRG claim.
    • Reviews. processes and adjudicate claims for payment accuracy or denial of payment according to Department’s policy and procedures.
    • Processes all claims accurately conforming to quality and production standards and specifications in a timely manner.
    • Documents resolution of claims to support claim payment and/or decision.
    • Makes benefit determinations and calculations of type and level of benefits based on established criteria and provider contracts.
    • Understands and interprets health plan Division of Financial Responsibilities and contract verbiage.
    • Determines out-of-network and out-of-area services providers and processes in accordance with company and governmental guidelines.
    • Adjudication of Commercial and Medicare Advantage claims.
    • Ability to prioritize, multitask and manage claims assignment within department goals and regulatory compliance and with minimal supervision.
    • Ability to make phone calls to Provider/Billing offices, when necessary, based on department guidelines.
    • Requests additional information or follow up with provider for incomplete or unclean claims.
    • Ability to effectively communicate with External and Internal teams to resolve claims issues.
    • Ability to interact in a positive and constructive manner.

    Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.


    Qualifications


    Experience

    • Minimum of 5 years’ experience in processing all types of professional, ancillary and institutional claims in Managed Care.
    • Comprehensive knowledge of various fee schedules and CMS pricers for professional, facility and ancillary claims.
    • Comprehensive knowledge of CPT, ICD-9 and ICD-10 codes, inpatient procedure coding, HCPCS, Revenue Codes, medical terminology and COB required.
    • Working knowledge of Claims Information systems.
    • Understands division of financial responsibility for determination of financial risk.
    • Type a minimum of 45 words per minute.

    Education

    High School diploma

  • 16 Days Ago

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Disability Insurance Program Representative
  • California Employment Development Department (EDD)
  • Santa Ana, CA FULL_TIME
  • INDEED APPLICATIONS WILL NOT BE CONSIDERED, PLEASE APPLY THROUGH CALCAREERS Job Description and Duties Under supervision, the Disability Insurance (DI) Services Representative will determine claimant ...
  • 4 Days Ago

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Fingerprint Examiner (Part-Time)
  • City of Santa Ana
  • Santa Ana, CA PART_TIME
  • The City of Santa Ana is looking for individuals who are results-oriented, possess great attitude, demonstrate creativity and innovation, work efficiently, show a record of success and have a passion ...
  • 2 Days Ago

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Staff Attorney
  • Elder Law and Disability Rights Center
  • Santa Ana, CA FULL_TIME,PART_TIME
  • Elder Law and Disability Rights Center (ELDR), a non-profit law firm, is seeking a part-time (15-20 hrs/wk) or full-time (35 hrs/wk) Attorney to join our dedicated team. The ideal candidate is passion...
  • 4 Days Ago

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Claims Processor
  • Hansen and Adkins Auto Transport
  • Los Alamitos, CA FULL_TIME
  • With nearly three decades of continuous growth and no signs of slowing down, Hansen & Adkins Auto Transport, Inc. (“H&A”) is dedicated to providing high quality, cost-effective vehicle transportation ...
  • 19 Days Ago

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Claims Specialist
  • Illumination Foundation
  • Santa Ana, CA FULL_TIME
  • “Every person deserves compassion, dignity, and the safety of a place to call home.”Homelessness is the largest social and public health crisis in California. Illumination Foundation (IF) is a growing...
  • 24 Days Ago

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0 Disability Claims Examiner jobs found in Santa Ana, CA area

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Senior Claims Examiner Workers Compensation - Hybrid
  • Sedgwick
  • Pasadena, 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...
  • 3/28/2024 12:00:00 AM

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REMOTE Lawyer - Civil Litigation
  • Civil Litigation Law Firm
  • Santa Ana, CA
  • Job Description Job Description *** $5,000 signing bonus *** We are currently hiring experienced litigators/litigation a...
  • 3/28/2024 12:00:00 AM

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Attorney Lawyer - Litigation - REMOTE
  • Law Firm - California
  • Huntington Beach, CA
  • Job Description Job Description *** $5,000 signing bonus *** We are currently hiring experienced litigators/litigation a...
  • 3/28/2024 12:00:00 AM

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Legal Claims Rep
  • Manpower
  • El Segundo, CA
  • Our client, Legal Industry is seeking a Claims Examiner to join their team. As a Legal Claims Examiner you will be part ...
  • 3/27/2024 12:00:00 AM

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Litigation Attorney - REMOTE
  • Colman Perkins Law Group
  • Irvine, CA
  • Job Description Job Description *** $5,000 signing bonus *** We are currently hiring experienced litigators/litigation a...
  • 3/27/2024 12:00:00 AM

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Post Bar-Law Clerk - Workers' Compensation
  • AmTrust Financial
  • Irvine, CA
  • Post Bar-Law Clerk - Workers' Compensation Job Locations US-CA-TBD | US-CA-Concord | US-CA-Irvine Requisition ID 2024-16...
  • 3/27/2024 12:00:00 AM

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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...
  • 3/25/2024 12:00:00 AM

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Lawyer - Litigation - REMOTE
  • Civil Litigation Law Firm
  • Fullerton, CA
  • Job Description Job Description *** $5,000 signing bonus *** We are currently hiring experienced litigators/litigation a...
  • 3/25/2024 12:00:00 AM

Santa Ana /ˌsæntə ˈænə/ (Spanish for "Saint Anne") is the county seat and second most populous city in Orange County, California in the Los Angeles metropolitan area. The United States Census Bureau estimated its 2011 population at 329,427, making Santa Ana the 57th most-populous city in the United States. Santa Ana is in Southern California, adjacent to the Santa Ana River, about 10 miles (16 km) from the coast. Founded in 1869, the city is part of the Greater Los Angeles Area, the second largest metropolitan area in the United States, with almost 18 million residents in 2010. Santa Ana is a ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Disability Claims Examiner jobs
$55,655 to $69,097
Santa Ana, California area prices
were up 2.5% from a year ago