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Claims manager Jobs in Covina ca

Last updated: 16 hours ago
Claims Auditor

Claims Auditor

Prospect MedicalCA, United States
Full-time
Show moreLast updated: 28 days ago
  • Promoted
  • New!
WORKERS COMPENSATION SR. CLAIMS EXAMINER

WORKERS COMPENSATION SR. CLAIMS EXAMINER

CCCSIG Contra Costa County Schools Insurance GroupCA, United States
$95,302.86–$115,841.22 yearly
Full-time
Show moreLast updated: 16 hours ago
Sr. Medical Malpractice Claims Manager - Professional Liability •Remote •

Sr. Medical Malpractice Claims Manager - Professional Liability •Remote •

ProvidenceCA, United States
$51.16–$82.36 hourly
Remote
Full-time
Show moreLast updated: 30+ days ago

Show moreLast updated: 30+ days ago
  • Promoted
Medical Claims Examiner

Medical Claims Examiner

Ultimate StaffingCA, United States
$24.00 hourly
Temporary
Show moreLast updated: 5 days ago
  • Promoted
Claims Examiner

Claims Examiner

TPI Global SolutionsCA, United States
Temporary
Show moreLast updated: 30+ days ago
  • Promoted
  • New!
MEDICAL CLAIMS EXAMINER

MEDICAL CLAIMS EXAMINER

Ultimate Staffing ServicesEl Monte, CA, United States
Full-time
Show moreLast updated: 22 hours ago
Assistant Manager, Claims Investigator

Assistant Manager, Claims Investigator

ManulifeRemote, CA
Remote
Full-time
Show moreLast updated: 30+ days ago
Claims Auditor

Claims Auditor

Innovative Management Systems IncorporatedCity of Industry, California, United States, 90601
$33.00 hourly
Show moreLast updated: 28 days ago
Claims Examiner

Claims Examiner

Lucent HealthCA, US
$20.00–$25.00 hourly
Show moreLast updated: 30+ days ago
  • Promoted
Medicare Claims Senior Manager

Medicare Claims Senior Manager

VirtualVocationsWhittier, California, United States
Full-time
Show moreLast updated: 1 day ago
  • Promoted
Senior Claims Examiner - California Workers' Comp

Senior Claims Examiner - California Workers' Comp

Athens AdministratorsCA, United States
Full-time
Show moreLast updated: 3 days ago
  • Promoted
Workers' Compensation Claims Examiner | Remote

Workers' Compensation Claims Examiner | Remote

King's Insurance StaffingCA, United States
$40.00–$50.00 hourly
Remote
Permanent +1
Show moreLast updated: 12 days ago
Claims Specialist

Claims Specialist

PRS Holdings Inc.Mira Loma, California, United States, 91752
Show moreLast updated: 28 days ago
Claims Investigator -Experienced

Claims Investigator -Experienced

Command InvestigationsOrange County, CA, US
Full-time
Quick Apply
Show moreLast updated: 30+ days ago
  • Promoted
Claims Manager - Remote - California

Claims Manager - Remote - California

Insurance ReliefCA, United States
$110,000.00–$115,000.00 yearly
Remote
Full-time
Show moreLast updated: 30+ days ago
Claims Examiner

Claims Examiner

Staffmax Staffing & RecruitingWhittier
$26.00–$29.00 hourly
Show moreLast updated: 30+ days ago
Senior Claims Examiner

Senior Claims Examiner

PIH HealthWhittier, California
Show moreLast updated: 30+ days ago
Claims Adjuster - Casualty

Claims Adjuster - Casualty

SedgwickRemote, CA
Full-time
Show moreLast updated: 30+ days ago
Claims Auditor

Claims Auditor

Prospect MedicalCA, United States
28 days ago
Job type
  • Full-time
Job description

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