Top 3 Claims examiner Jobs in Bakersfield, Ca

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Claims Examiner I
Kern Health Systems —Bakersfield, CA
- $21.15 - $31.73 an hour
- Full-time
- High school diploma or GED
- Organizational skills
- SharePoint

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Healthcare Application Analyst III – Hybrid (Must Reside Within Driving Distance; On-Site 1 Week/Month)
Kern County Hospital Authority —Bakersfield, CA
If position responsibilities require driving a vehicle owned, leased or rented by Kern Medical, then possession of a current valid California Driver’s license,…
$51.83 - $69.66 an hour
Quick Apply
Facets Analyst
Revolution Technologies, LLC —United States
We’re looking for candidates who understand how Facets supports healthcare payer operations and have hands-on experience working with claims-related processes,…
$38.19 - $45.00 an hour
Quick Apply
11d

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Account Examiner 2 - (PN: 20067467)
State of Ohio - Workers' Compensation —Columbus, OH
There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.
$23.65 an hour
2d
Security Officer Enhanced Part Time Screening Examiner
Allied Universal —Columbus, OH
A valid driver’s license will be required for driving positions only. As a condition of employment, applicants will be subject to a background investigation in…
$19.75 an hour
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4d

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Claims Examiner I

Kern Health Systems -
Bakersfield, CA

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Job Details

Full-time
$21.15 - $31.73 an hour

Qualifications

High school diploma or GED

Full Job Description

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

Work Location: On-Site

About us

Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

About the role

Under management direction, responsible for reviewing and processing all types of medical and facility claims from contracting and non-contracting providers and from subscribers and enrollees for payment in an accurate and timely manner. Responsible for applying correct contract benefits, policies and procedures.
This position is responsible for claims auditing and payment functions for a Knox-Keene licensed health maintenance organization (HMO).

Essential Duties and Responsibilities

Resolve system suspended claims for:
PCPs
Labs
Radiology
Less complicated specialists
Physical Therapy

Deny inappropriate claims following policy guidelines.
Prepare claims that must be routed to other departments for further review.
Review difficult claims with guidance from Claims Supervisor.
Responsible for identifying billing errors and possible fraudulent claims submissions.
Obtain eligibility verification and other health insurance coverage by Internet or POS.
Responsible for correct manual calculation of benefits when applicable.
Responsible for identifying possible CCS eligible claims for further investigation.
Report overpayment refund requests on SharePoint log
Maintain productivity and quality in accordance with established guideline.
Perform other job-related duties as required.
Regular Predictable attendance.
Adheres to all company policies and procedures relative to employment and job responsibilities.

Employment Standards:
High School Diploma from an accredited school or equivalent.
Minimum of one (1) year medical Claims Examiner processing experience.
Individual must have good organizational skills and the ability to make good decisions.

Pay range shown reflects the full range for this position. Initial offers are typically positioned between the minimum and midpoint, based on qualifications and internal equity.

Pay Range: Minimum: $21.15 Mid-Point: $26.44 Maximum: $31.73

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

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Claims Examiner I

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