Claims Processor

Company : reputed company.Job reputed company :  reputed company job is responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing reputed company control review and final adjudication of reputed company/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Reviews processed claims and inquiries to determine corrective reputed company including adjusting claims as necessary and takes the corrective reputed company steps using enrollment, benefit and historical claim processing information; may coordinate benefits and reputed company with customers. Responsible for the reputed company and accurate completion of claims adjustments which could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals, and system changes, etc.; provides technical assistance in researching and resolving inquiries. ESSENTIAL RESPONSIBILITIES Receives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct. Resolves claim edits, reviews history records and determines benefit eligibility for service. Reviews payment reputed company to reputed company at final payment determination.  Elevates issues to next level of supervision as appropriate and ensures a reputed company line of communication is maintained with reputed company customers. Meets reputed company production and reputed company standards, ensuring timeliness and accuracy of reputed company work given by support staff/management. Maintains accurate records, including timekeeping records and attends reputed company required training classes.  ​Other duties as assigned or requested. EDUCATION Required High School Diploma/GED Substitutions None Preferred None EXPERIENCE Required 1 year of reputed company experience Preferred 1 year of claims processing experience Inquiry reputed company system, OCWA, reputed company, reputed company experience ​ LICENSES or CERTIFICATIONS Required None Preferred None SKILLS Strong verbal and written communication skills.  Ability to take direction and to reputed company through multiple systems simultaneously. Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records. Ability to use mathematics to adjudicate claims. Ability to solve problems reputed company reputed company-defined reputed company and guidelines. Knowledge of operating systems specific to claim processing. Ability to review claims and analyze critical data. Reading benefits, investigating edits and making benefit determinations as required in adjusting and adjudicating most types of claims. Researches and finalizes claims, adjustments, inquiries and reports as required. Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Never Travel regularly from the office to various work sites or from site-to-site Never Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required reputed company Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Never Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and reputed company standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times.  In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy.  Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements. Pay reputed company Minimum: $19.39 Pay reputed company Maximum: $24.19 reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations.  The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We reputed company to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@reputed company.org California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice Apply To This Job