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Claims Coordinator
Claims CoordinatorSolxsys Administrative Solutions, LLC • Walnut Creek, CA, US
Claims Coordinator

Claims Coordinator

Solxsys Administrative Solutions, LLC • Walnut Creek, CA, US
30+ days ago
Job type
  • Full-time
Job description

Summary

The Claims Coordinator will be responsible for medical, dental, and vision claims processing of claims submitted electronically or on hard copy. Each Coordinator will specialize in a Particular Client(s).

Excellent opportunity to get in on the ground floor of a company that includes employees as part of the team and delivers excellent wages and benefits.

GENERAL DUTIES AND RESPONSIBILITIES including but not limited to:

  • Review claims for benefit determination based on work queue, electronic or hard copy submissions.
  • Make corrections when necessary to incorrect Participant or Provider data when authorized.
  • Assist Member Service Representatives with difficult claim issues.
  • Primary responsibilities will not include telephone or personal interaction with participants or providers unless; it is determined by a supervisor or manager that assistance is needed in this area.

Requirements:

  • 2-3 Years of Claims Processing experience
  • Coordinator must be able to determine benefits for multiple groups and process claims accurately according to the corresponding Plan Documents.
  • Coordinator will be expected to process X number of claims (based on Plan complexity) and maintain an accuracy rate of 98% procedure and 99% financial.
  • Ability to read, write and speak Spanish is preferred, but not required
  • Medical terminology classes, knowledge of medical billing and codes ICD9 and CPT coding is a plus.

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Claims Coordinator • Walnut Creek, CA, US

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