Top 711 claims examiner Jobs

Temporary Claims Examiner II
Partnership HealthPlan of California —Redding, CA
- $28 an hour
- Temporary
- Research
- Mid-level
- Office
Examiner Physician Assistant
Loyal Source —Eugene, OR
- $165,921.60 - $195,921.60 a year
- Monday to Friday
- Microsoft Word
- Microsoft Outlook
- Military
Quick Apply
Examiner Nurse Practitioner
Loyal Source —Pumpkin Center, NC
- $106,873.60 - $196,873.60 a year
- Microsoft Word
- Nursing
- Microsoft Outlook
Quick Apply
Examiner Nurse Practitioner
Loyal Source —Eugene, OR
- Monday to Friday
- Microsoft Word
- Nursing
- Microsoft Outlook
Quick Apply
Examiner Physician Assistant
Loyal Source —Cedar Rapids, IA
- $136,593 - $166,593 a year
- Monday to Friday
- Microsoft Word
- Microsoft Outlook
- Military
Quick Apply
Examiner Physician Assistant
Loyal Source —Tulsa, OK
- $135,158 - $165,158 a year
- Monday to Friday
- Microsoft Word
- Microsoft Outlook
- Military
Quick Apply
Examiner Physician Assistant
Loyal Source —Fayetteville, NC
- $136,864 - $166,864 a year
- Microsoft Word
- Microsoft Outlook
- Military
Quick Apply
Examiner Nurse Practitioner
Loyal Source —Rocklin, CA
- $149,572 - $179,572 a year
- Monday to Friday
- Microsoft Word
- Nursing
- Microsoft Outlook
Quick Apply
Senior Claims Examiner
Berkley —Irvine, CA
- $110,000 - $125,000 a year
- Full-time
- Hybrid work
- Background check
- Spanish
- Bachelor of Science
- Profit sharing
- Health insurance
Quick Apply
Examiner Nurse Practitioner
Loyal Source —Fresno, CA
- $147,784 - $177,784 a year
- Monday to Friday
- Microsoft Word
- Nursing
- Microsoft Outlook
Quick Apply
Liability Claims Examiner - NY
GREATER NEW YORK MUTUAL INSURANCE COMPANY —Manhattan, NY
- $69,100 - $124,400 a year
- Writing skills
- Mid-level
- Analysis skills
Real Estate Title Examiner / Post Closer (Non-Remote Position)
Network Title Agency of NY LLC —Buffalo, NY
- From $17 an hour
- 8 hour shift
- English
- Research
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Workers' Compensation Claims Examiner
JT2 Integrated Resources —California
- From $90,000 a year
- Full-time
- Mid-level
- 3 years
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
Claims Examiner II
Massachusetts Property Insurance Underwriting Association —Boston, MA
- $80,700 - $121,000 a year
- Full-time
- Hybrid work
- Computer literacy
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Personal Injury Examiner
GEICO —Tampa, FL
- $47,150 - $72,775 a year
- Full-time
- Office
- Bachelor's degree
- Entry level
- Health insurance
- Tuition reimbursement
7d
Casualty Claims Examiner ($2,500 Sign-On)
GEICO —Richardson, TX
- Full-time
- Hybrid work
- Office
- Senior level
- Communication skills
- Health insurance
- Tuition reimbursement
7d
Personal Injury Claims Examiner
GEICO —Marlton, NJ
- $27.47 - $42.73 an hour
- Full-time
- Office
- Bachelor's degree
- Entry level
- Health insurance
- Tuition reimbursement
7d
Injury Examiner
USAA —Colorado Springs, CO
- $85,040 - $162,550 a year
- Hybrid work
- Anatomy knowledge
- Military
- Office
- Paid holidays
- Health insurance
Senior Claims Examiner - Workers' Compensation
Gallagher —Rancho Cordova, CA
- $74,000 - $106,000 a year
- Full-time
- Remote
- 5 years
- High school diploma or GED
- Bachelor's degree
- Paid parental leave
- Health savings account
3d
Senior Claims Examiner - MSI
The Baldwin Group —Remote
- Full-time
- Remote
- Residential
- Bachelor's degree
- Mentoring

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Temporary Claims Examiner II

Partnership HealthPlan of California -
Redding, CA

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Job Details

Temporary | Full-time
$28 an hour

Qualifications

High school diploma or GED
Typing

Full Job Description

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 claims worksheets. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters, as necessary. Routes and tracks claims requiring review by other staff and departments, and processes when possible. Claims Examiner II is distinguished from Claims Examiner I by a higher level of autonomy and experience, as well as an ability to process a wider range of claim types.

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.
Identifies and reports trends of pending claims that are increasing or processes that appear dated.
Recognizes and gives feedback to management on procedure changes that would result in more efficient operations.
Other duties as assigned.

Qualifications:

Education and Experience

High school diploma or equivalent; minimum one (1) year in Medi-Cal billing and/or claims examining experience in an automated environment.

Special Skills, Licenses and Certifications

Effective written and oral communication skills. Good organization skills. Knowledge of claims processing and/or Medi-Cal billing, CPT, and ICD-10 knowledge preferred.

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. Consistently meets production standards without compromising quality on all tasks.

Work Environment And Physical Demands

Ability to use a microcomputer keyboard. More than 95% 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:

$28.00/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.

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Refine Your Search

claims examiner jobs

Temporary Claims Examiner II

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Injury Examiner

Senior Claims Examiner - Workers' Compensation

Senior Claims Examiner - MSI

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