Plans examiner Jobs in Santa Clara, CA
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Plans examiner • santa clara ca
Last updated: 5 days ago
Orange, CA is a premier healthcare provider specializing in Medicare and HMO services.With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize acc...Show moreLast updated: 24 days ago
Mobile Phlebotomist / Paramedical Examiner.On-Call and At-Will equal Flexibility! You will choose the days and hours you wish to work and the areas you wish to work in.
You manage your calendar of ava...Show moreLast updated: 30+ days ago
A municipal government agency in San José is seeking a Chief Investment Officer to lead investment strategies for its pension plans and work collaboratively with external professionals.Candidates m...Show moreLast updated: 6 days ago
A company is looking for a Title Examiner to handle title work and examinations for multiple states.Key Responsibilities Handle title work and compile, research, and present title commitments bas...Show moreLast updated: 30+ days ago
Put your Insurance Experience to work – FROM HOME!.Our unique platform provides you with.WHAT YOU’LL LOVE ABOUT WAHVE.We created a welcoming place to work with friendly and professional...Show moreLast updated: 5 days ago
Workers Compensation Claims Examiner | Va Jurisdiction | Remote.By joining Sedgwick, you'll be part of something truly meaningful.
It's what our 33,000 colleagues do every day for people around the ...Show moreLast updated: 23 days ago
Claims Examiner - Construction Defect.DUAL North America is seeking a Casualty Examiner for the Construction Defect Claims team.
At DUAL, Casualty Examiners play a critical role in managing and reso...Show moreLast updated: 21 days ago
Additional Job Details Agile program management for Elixir, Legato v2 and consumer integrations.Show moreLast updated: 30+ days ago
- Promoted
Claims Examiner I
Astiva Health, IncSan Jose, CA, USFull-time
Mobile Phlebotomist / Paramedical Examiner
Quest DiagnosticsMilpitas, California, United StatesPart-time
Quick Apply
- Promoted
Chief Investment Officer, Pension & Retirement Plans
City of San JoséSan Jose, CA, USFull-time
Title Examiner
VirtualVocationsSanta Clara, California, United StatesFull-time
Commercial Auto Claims Adjuster / Examiner - REMOTE
Work At Home Vintage ExpertsSan Jose, CA, USRemote
Full-time +2
Quick Apply
- Promoted
Workers Compensation Claims Examiner | VA Jurisdiction | Remote
SedgwickSan Jose, CA, USRemote
Full-time
- Promoted
Claims Examiner - Construction Defect
HowdenSan Jose, CA, USFull-time
- Promoted
Project Manager (Risk, Resource plans, Cost estimates) | Sunnyvale, CA - Onsite
SamprasoftSunnyvale, CA, USFull-time
The average salary range is between $ 67,824 and $ 130,481 year , with the average salary hovering around $ 83,598 year .
- general dentist (from $ 182,063 to $ 250,000 year)
- engineering director (from $ 164,115 to $ 238,917 year)
- product director (from $ 170,327 to $ 237,736 year)
- director of engineering (from $ 153,327 to $ 236,900 year)
- planning engineer (from $ 123,773 to $ 236,343 year)
- technical director (from $ 131,250 to $ 235,000 year)
- software architect (from $ 167,558 to $ 231,450 year)
- product management (from $ 145,000 to $ 230,849 year)
- software engineering manager (from $ 175,500 to $ 229,381 year)
- audio engineering (from $ 175,500 to $ 228,100 year)
- Ventura, CA (from $ 89,525 to $ 258,303 year)
- Everett, WA (from $ 87,575 to $ 180,905 year)
- Boulder, CO (from $ 68,250 to $ 150,000 year)
- Miami, FL (from $ 67,985 to $ 135,745 year)
- Santa Ana, CA (from $ 67,824 to $ 130,481 year)
- Santa Clarita, CA (from $ 67,824 to $ 130,481 year)
- Santa Clara, CA (from $ 67,824 to $ 130,481 year)
- Santa Rosa, CA (from $ 67,816 to $ 128,364 year)
- Sacramento, CA (from $ 20,800 to $ 124,800 year)
- Fremont, CA (from $ 120,448 to $ 124,585 year)
The average salary range is between $ 56,179 and $ 91,645 year , with the average salary hovering around $ 68,731 year .
Claims Examiner I
Astiva Health, IncSan Jose, CA, US24 days ago
Job type
- Full-time
Job descriptionGood knowledge of CPT / HCPCS / ICD-10, and Revenue Codes, including modifiers. Assist customer service as needed to assist in claims resolution on calls from providers. Research authorizations and properly selects appropriate authorization for services billed. Coordinate with the claims clerks on issues related to the submission and forwarding of claims determined to be financial responsibility of another organization. Coordinate Benefits on claims for which member has another primary coverage Run monthly reports. Review pre and post check run. Regular and consistent attendance Other duties as assigned High School Diploma or GED required. 1 to 3 years of previous experience in a health plan, IPA or medical group. Strong understanding of the benefit process including member services or customer service. Demonstrated proficiency in MS Office (Excel, Word, Outlook, and PowerPoint). Able to navigate difficult situations with empathy, discretion, and professionalism. Strong understanding of Senior Medicare Advantage Health plans. Able to explain member benefits, answer questions and concerns using a "Customer Service First" attitude. Able to live our mission, vision, and values, Bilingual in another language (written and oral) preferred.
About Us : Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.
SUMMARY : Under the direction of the Vice President of Claims, this position is responsible for manual input and adjudication of claims submitted to the health plan. The ideal candidate will need to interpret and utilize capitation contracts, payor matrixes, subscriber benefit plan, and provider contracts; as well as resolving customer service inquiries, status calls, andclaim tracers.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following :
- Data enter paper claims into EZCAP.
- Review and interpret provider contracts to properly adjudicate claims.
- Review and interpret Division of Financial Responsibility (DOFR) for claims processing.
- Perform delegated duties in a timely and efficient manner.
- Verify eligibility and benefits as necessary to properly apply co-pays.
- Understands eligibility, enrollment, and authorization process.
- Knowledge of prompt payment guidelines for clean and unclean claims
- Process claims efficiently and maintains acceptable quality of at least 95% on reviewed claims.
- Meets daily production standards set for the department.
- Prepares claims for medical review and signature review per processing guidelines.
- Identify the correctly received date on claims, with knowledge of all time frames for meeting compliance for all lines of business.
Maintains good working knowledge of system / internet and online tools used to process claims
QUALIFICATION REQUIREMENTS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and / or EXPERIENCE :