Top 3 Claims adjudicator/processor Jobs

Claims Adjudicator Sr
Loma Linda University Health —Redlands, CA
- $26.03 - $32.51 an hour
- Full-time
- Microsoft Outlook
- Management
- 5 years
Insurance Collector I
HEALTH ADVOCATES —Chatsworth, CA
- $24.00 - $31.25 an hour
- Full-time
- Computer literacy
- HIPAA
- Office
- Health insurance
- Employee assistance program
Medical Biller I
HEALTH ADVOCATES —Chatsworth, CA
- $21.00 - $27.25 an hour
- Full-time
- HIPAA
- Mid-level
- Office
- Health insurance
- Employee assistance program

More jobs to discover

Find similar jobs that you might be interested in.

Medical Bill Collector
Komyatte & Casbon, P.C. —Highland, IN
Answering incoming calls and making outgoing calls in a fast-paced collections environment. Ability to handle a high volume of both incoming and outgoing…
From $15 an hour
Quick Apply
Treasurer/Collector
Town of Auburn —Auburn, MA
We are seeking a dynamic and detail-oriented Treasurer/Collector to join our organization, a vital role responsible for managing the organization’s financial…
$90,000.00 - $97,640.70 a year
Quick Apply

I want to receive the latest job alert for claims adjudicator/processor

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

claims adjudicator/processor jobs near

Medical Biller jobs in Hawaii

Medical Biller jobs in Salina, KS

Medical Biller jobs in Ohio

Medical Assistant No Experience jobs in Columbus, OH

Medical Coding jobs in Tyler, TX

Medical Assistant jobs in Kent, WA

Medical Biller jobs in New Jersey

Claims Adjudicator jobs in Miami, FL

Claims Adjuster jobs in Missouri

Field Claims Adjuster jobs in North Carolina

Remote Claims jobs in San Diego, CA

Remote Claims jobs in Raleigh Durham, NC

Claims Adjudicator jobs in Arizona

Claims Adjudicator jobs in Seattle, WA

Specimen Collector jobs in Indiana

Drug Test Collector jobs in Boston, MA

Tax Collector jobs in Miami, FL

Specimen Collector jobs in Oklahoma City, OK

Medical Collector jobs in Boca Raton, FL

Claims Adjudicator Sr

Loma Linda University Health -
Redlands, CA

Apply Now

Job Details

Full-time
$26.03 - $32.51 an hour

Qualifications

Medical claims processing
Managed care
Managed care organization experience
Employee relationship building
High school diploma or GED
Driver's License

Full Job Description

Department: UHC: Managed Care

Job Summary: The Claims Adjudicator Sr is responsible mentoring and training Claims Adjudicators. The Lead will also analyze and process professional and hospital HMO Risk claims in accordance with the managed care contract provisions in an accurate and timely manner. Responds to questions from other adjudicators and processors. Verifies system assigned risk pool determination in accordance with the Division of Financial Responsibility matrix. Assists Director in creating, reviewing, and enhancing policies and procedures governing full risk claims processing on an annual basis or as needed. Assists other adjudicators and/or examiners as needed in order to assure that claims are completed within standards. Performs other duties as needed.

Education and Experience: High School Diploma or GED required. Associate's Degree preferred. Minimum five years managed care claims processing experience with professional and/or institutional claims required.

Knowledge and Skills: Extensive experience in health insurance claims processing, HMO claims or managed care environment is required, in-depth knowledge of medical billing and coding, knowledge of health insurance, HMO and managed care principles. Claims Payment System including Claim Hierarchy Categories, CPT, ICD-10, HCPCS, UB-04. Knowledge in UB and HCFA-1500 Insurance Claims, reading and interpreting Contracts and DOFR. Understanding of all CMS guidelines and regulations in relation to Claims Processing and Payments. Able to read; write legibly; speak in English with professional quality; use computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position; Able to relate and communicate positively, effectively, and professionally with others; work calmly and respond courteously when under pressure; collaborate and accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.

Licensures and Certifications: Valid California Driver's License required at time of hire.

Apply Now

Refine Your Search

claims adjudicator/processor jobs

Claims Adjudicator Sr

Insurance Collector I

Medical Biller I

More jobs to discover

I want to receive the latest job alert for claims adjudicator/processor

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected