$80K - $90K + 5% discretionary bonus + full benefits + 401K
The Senior Claims Reporting Analyst will create and maintain reports supporting all functional areas of claims production, adjustments, recoveries, auditing, compliance and KPI utilizing SSIS, SSRS, SSAS, SQL, MS Access and EXCEL. This role focuses on improving exception data/items that do not automatically get processed for payment. This position requires strong Excel, SQL, MS Access and Microsoft Business Intelligence skills.
Do you want to work for the leader of health insurance coverage’s? This company’s network spans more than 5,000 square miles and thousands of healthcare providers. This organization provider healthcare to low income communities and residents throughout the Los Angeles County area. They are seeking candidate for their Downtown Los Angeles office for the following position:
The Claims Examiner III is responsible for the processing and releasing of hospital or medical claims according to ...
Claims Supervisor with EZ-Cap Experience Needed Immediately!
Date Posted: Oct. 09, 2013
Position: Claims Examiner
Location: Long Beach, California
Salary: $14-$15 hourly, DOE
Position Summary- Candidate will be responsible for claims adjudication and preparation for payment. Two to three years experience in ...
The Human Resources Specialist (for risk management) provides strategic recommendations for policy development and tactical oversight and/or support of the Human Resources risk management program, including legal and regulatory compliance, safety program participation and support, support and development of Company safety programs and incentives; and management of workers compensation reports and claims.
PAY: $50k to $75k per year, depending on experience
Under the direction of the Claims Manager, the Claims Examiner II is responsible for processing of complex claims and adjudication and claims research when necessary. Must meet and/or exceed qualitative and quantitative production standards.
Essential duties and responsibilities include but are not limited to:
1. Responsible for processing contracted/non-contracted hospital/professional claims based on CMS Regulatory Guidelines.
2. Responsible for meeting measurement standards for ...
The Claims Examiner III is responsible for the processing and releasing of hospital or medical claims according to established policies and procedures. Must identify procedural and system inefficiencies and work with the appropriate entities to resolve issues. Examiners also perform research, analyses, reporting and special projects as assigned. Examiners must be able to meet production requirements and quality standards.
• 3 years or more experience in processing HMO ...
Description: Duties to include but not limited to conducting claims processing audits and ensure Participating Provider Group (PPGs) or IPAs meet the regulatory requirements for processing claims. Tracks and monitors the PPG/IPA’s corrective action plan. Assists in internal claim audits and processing of claims adjustments and/or provider disputes claims.
Qualification: Candidate must have a minimum education AA degree and/or 4 -5 yrs medical claims processing experience in HMO setting & claims ...
This MSO needs candidates with strong claims examining experince! Company offers excellent medical, dental, education, and retirement benefits. Group provides opportunities for community involvement, employee events, and advancement potential. Working under the direction of the Claims Manager, this position is responsible for processing commercial and/or hospital claims in a timely and accurate manner with attention to guidelines and company policies. This position also processes routine EDI claims ...
Supervise up to 6 claims examiners investigating, evaluating, reserving, negotiating and resolving serious and complex construction defect claims.
*** Develop strategies and negotiate claims to timely conclusion.
*** Review and analyze construction contracts and documents and legal pleadings in order to identify coverage.
*** Evaluate liability and damages.
*** Identify and pursue all recovery opportunities
*** Identify suspicious claims and refer or handle appropriately
Oversee the handling, reviewing and coordination activities involved in complex long tail and latent type claims.
Required experience includes, but is not limited to: Reviewing loss notices, interpreting policy coverage, establishing reserves, handling claims involving primary, excess, and umbrella coverage, coordinating defense counsel, expert witnesses, and generally supporting defense, evaluating liability and damages, aiding in the development and improvement of claims handling techniques, ...
SUMMARY: Overpayment and Recovery is responsible for conducting a thorough post-payment audit of provider claims identifying overpayments and initiating recoupment
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Maintain current knowledge of all ICD-9, CPT, HCPC codes and their changes, general billing procedures for health care providers and institutions, Medicare and Medi-Cal reimbursement guidelines.
Maintain knowledge of Company policies and procedures
Generates and Utilizes reports for ...
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