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Claims Examiner I/II

Date: 06/25/2015

Description: Under management direction, responsible for reviewing and processing all types of medical and facility claims from contracting and non-contracting providers and from subscribers and enrollees for payment in an accurate and timely manner.  Responsible for applying correct contract benefits, policies and procedures.
Requirements: Claims Examiner I a minimum of one (1) year medical claims payment-processing experience. One (1) year billing experience with a physician’s office may be substituted for one (1) year medical claims payment processing experience. The Claims Examiner II  minimum of two (2) years of medical claim payment or medical billing processing and COB investing experience.  High school diploma from an accredited school or equivalent. Typing certificate of 30 net words per minute within one year of issuance. 

Knowledge of computerized on-line data entry systems, organizational structure, methods and procedures utilized in medical claims processing, medical terminology, CPT & ICD-9 coding.  Ability to adapt to a rapidly evolving work environment, work independently, communicate with a variety of personnel and providers.  Possession of valid California Driver License and proof of State required auto liability insurance.

We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits.  As a condition of employment, a satisfactory drug test and background check are required. E.O.E.

Req# 301-15