Administrative Coordinator

Description :

Title : Claims Examiner III

Location : 5767 West Century Blvd #400

Los Angeles, CA 90045

Duration : 13 weeks

Shift : M-F, 8-5

The Claims Examiner III is responsible for the accurate and timely data entry, review and adjudication of professional, ancillary and institutional claims for services rendered in the inpatient, ambulatory and outpatient settings for all contracted lines of business in accordance with regulatory guidelines, contract provisions and established policies and procedures. Receives work assignments via batch, report, in-basket pools, work queues or other methods. The incumbent is responsible for meeting quality, productivity, service-level and turn-around requirements in accordance with the department s performance standards and regulatory requirements. This role must have the ability to research and resolve complex claim issues as well as train others on claims processes and workflows.

The ideal candidate will have :

• Professional, ancillary, and institutional claims adjudication experience (UB04 and CMS-1500)
• Strong working knowledge of contract terms, DOFRs, fee schedules, and benefit plan application
• Proven ability to research, investigate, and resolve complex claim issues independently
• Familiarity with CMS, HIPAA, and state regulatory guidelines
• Experience generating EOBs and ensuring compliance with established policies
• A background in mentoring, training, or supporting peers on claims workflows and best practices