Claims Processor - Intermediate

Specific Duties:
1. HMO Claims adjudication experience, processing at least 175 claims per day for all types of products (Medi-Cal, Medicare and Commercial claims), professional as well as hospital.
2 ability to read and interpret health plan DOFR (Division Of Financial Responsibility)
3. Knowledge of health plan and government guidelines and regulation
4. knowledge of how to read and interpret providers contracts and apply them to claims
5. Knowledge of processing claims for IPA and Hospital

Must have qualifications/experience:
1. 3+ years of experience in a related environment (i.e. IPA, Medical Group and hospital settings
2. 1+ years of processing mental health claims.
3. • An education level of at least a high school diploma or GED OR equivalent years of work experience
4. • Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
5. Making claims a positive experience for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life's best work.

Shift Start/End Time: 7:30am - 4:00pm

Dress Code: Business Casual

  • Apply with Adecco

Reference number US_EN_99_022862_1197972