Claims Examiner

Job Description Job Position: Claims Examiner Location: Whittier, CA Shift: 40 hours weekly (7 :00AM-4:30PM) Hourly Pay Rate: $27/hr POSITION SUMMARY: The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients. 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER EDUCATION EDUCATION/EXPERIENCE/TRAINING: • High school graduate or equivalent required. Must have physical proof on hand if background check is unable to verify your education background. • Minimum of 2 years claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environment • Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services * Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims * Knowledge of compliance issues as they relate to claims processing • Experience in interpreting provider contract reimbursement terms desirable • Ability to identify non-contracted providers for Letter of Agreement consideration • Data entry experience • Training on basic office automation and managed care computer syste