Northridge, CA 91201
Are you looking to join a well-established healthcare organization who puts an emphasis on quality patient care? Well this might be the right place for you!
Our client, a large healthcare organization, is in need of a Medical Claims Examiner/Claims Specialist to be hired on a full-time, permanent basis. The main responsibilities include determining insurance coverage, examining and resolving medical claims, documenting actions, maintaining quality customer service, and ensuring legal compliance.
- Determines covered medical insurance losses by studying provisions of policy or certificate
- Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims
- Documents medical claims actions by completing forms, reports, logs, and records
- Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter
- Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations
- Maintains quality customer services by following customer service practices; responding to customer inquiries
- Experience in Medical Claims Processing (preferably working with HMO)
- Strong understanding of Managed Care Healthcare environment
- Excellent customer service skills
- Demonstrated ability to meet or exceed production requirements
Why work here:
- Full benefits package including medical, dental, life insurance, generous PTO, 401K
- Opportunities for advancement in a stable, growing organization
- Inclusive company culture, employee perks!
This is a direct-hire, permanent placement, full-time opportunity with benefits.