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Claims manager Jobs in Covina ca
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WORKERS COMPENSATION SR. CLAIMS EXAMINER
CCCSIG Contra Costa County Schools Insurance GroupCA, United StatesSr. Medical Malpractice Claims Manager - Professional Liability •Remote •
ProvidenceCA, United States- Promoted
Medical Claims Examiner
Ultimate StaffingCA, United States- Promoted
- Promoted
- New!
MEDICAL CLAIMS EXAMINER
Ultimate Staffing ServicesEl Monte, CA, United StatesAssistant Manager, Claims Investigator
ManulifeRemote, CAClaims Auditor
Innovative Management Systems IncorporatedCity of Industry, California, United States, 90601- Promoted
Medicare Claims Senior Manager
VirtualVocationsWhittier, California, United States- Promoted
Senior Claims Examiner - California Workers' Comp
Athens AdministratorsCA, United States- Promoted
Workers' Compensation Claims Examiner | Remote
King's Insurance StaffingCA, United StatesClaims Specialist
PRS Holdings Inc.Mira Loma, California, United States, 91752Claims Investigator -Experienced
Command InvestigationsOrange County, CA, US- Promoted
Claims Manager - Remote - California
Insurance ReliefCA, United StatesClaims Examiner
Staffmax Staffing & RecruitingWhittierClaims Auditor
Prospect MedicalCA, United States- Full-time
The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and / or inquiry processing experience to audit and analyze simple to advanced-level claims processing procedures and workflows.
Job Responsibilities / Duties
- Apply claim processing experience to audit and analyze all levels of claims processing procedures and workflows. Requires the ability to audit claims accurately. Independently run reports on errors identified for potential error trends and report the results to Claims Management and Claims Trainer. Additionally assist in the processing of PDRs , Health Plan Cap Deducts, and claims processing.
- Handle special projects from external provider and internal departments. Must have the ability to accurately make the necessary adjustments for underpayments and review overpayment requests for Claims Recovery Specialist.
- Independently audit and analyze high dollar claims and checks prior to the issuance of funds. Must possess the ability to analyze Claims EOB and balance check amounts according to Claims processing guidelines.
- Analyze and prepare Health plan claims selections for Annual health plan audit. Review samples provider by clerical staff and ensure claims payments are accurate and all documentations required by the health plan auditor is present at the time of audit.
- Assist the Recovery Specialist in corresponding with external providers regarding Claims Overpayment requests. Requires the ability to communicate and analyze Claims processing methodologies according to CMS and DMHC guidelines.
Qualifications
Minimum Education : High School Diploma or Equivalent. BS / BA preferred.
Minimum Experience : Two to three (2-3) years previous experience as medical claims Auditor or 3-5 years previous experience examining medical Claims preferred. Preferably in an IPA, MSO, or Medical Group setting.
Req. Certification / Licensure : None