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Senior Claims Examiner
Senior Claims ExaminerWelbeHealth • Los Angeles, California, USA
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Senior Claims Examiner

Senior Claims Examiner

WelbeHealth • Los Angeles, California, USA
30+ days ago
Job type
  • Full-time
Job description

At WelbeHealth we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population while serving as a care provider and care plan to those individuals we serve.

Our Health Plan Services team helps ensure excellent care delivery for our participants and the Senior Claims Examiner plays a pivotal role in ensuring timely and efficient processing of claims for our contracted specialty provider partners.

Essential Job Duties :

  • Examine claim records and forms to investigate and resolve first level disputes including completion of acknowledgement and determination letters
  • Review and process second level claims such as adjustments and corrected claims
  • Work closely with leadership on identified trends related to improper processing and claim-related concerns or discrepancies that result in a dispute
  • Assist the team in carrying out departmental responsibilities and collaborate with others to support short- and long-term goals and priorities

Job Requirements :

  • Minimum of three (3) years of experience with processing researching and adjudicating claims in a complex managed care environment
  • In depth experience with Medicare and Medicaid claims processing
  • Demonstrated skills within Microsoft Office Applications and electronic claims processing systems
  • Ability to balance competing priorities exercise discretion and consider all relevant factors in navigating gray areas and resolving ambiguities
  • Benefits of Working at WelbeHealth : Apply your claims expertise in meaningful ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.

  • Medical insurance coverage (Medical Dental Vision) starting day one of employment
  • Work / life balance we mean it! 17 days of personal time off (PTO) 12 holidays observed annually sick time
  • Advancement opportunities - Weve got a track record of hiring and promoting from within meaning you can create your own path!
  • And additional benefits
  • Salary / Wage base range for this role is $68640 - $81395.73 / year Bonus Equity. WelbeHealth offers competitive total rewards package that includes 401k match healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications.

    Compensation

    $68640 - $81395.73 USD

    COVID-19 Vaccination Policy

    At WelbeHealth our mission is to unlock the full potential of our vulnerable this spirit please note that we have a vaccination policy for all our employees and proof of vaccination or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

    Our Commitment to Diversity Equity and Inclusion

    At WelbeHealth we embrace and cherish the diversity of our team members and were committed to building a culture of inclusion and belonging. Were proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race color religion sex gender gender identity gender expression sexual orientation marital or veteran status age national origin ancestry citizenship physical or mental disability medical condition genetic information or characteristics (or those of a family member) pregnancy or other status protected by applicable law.

    Beware of Scams

    Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @ email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to

    Required Experience :

    Senior IC

    Key Skills

    Corporate Paralegal,Baan,IT Sales and Marketing,Civil Quality Control,Activex,Jboss

    Employment Type : Full-Time

    Experience : years

    Vacancy : 1

    Monthly Salary Salary : 68640 - 81395

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    Senior Claim Examiner • Los Angeles, California, USA

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