PrideStaff
Claims Processor
PrideStaff, Lake Forest, California, United States, 92630
Job DescriptionJob Description
Claims Processor
for a company in Foothill Ranch that serves medical providers, clients and patients.
This is a Temporary to Hire opportunity, pay rate $20-23/hr, depending on experience. Full-time, Monday - Friday, 7:00 AM - 4:00 PM, with a 1 hour unpaid lunch. This is 100% ON-SITE position. Ideal candidate will be organized and detail-oriented. Position offers mentorship and advancement opportunities.
Essential Responsibilities:
In the Claims Processor role, not only are you responsible for qualifying claims/bills for payment, you will also need to check for coverage and apply co-pay's deductible, and.check coinsurance
You will need to create cases and assist with incoming calls, as well as working closely with other departments
Import claims received into specified cases. Claims are received through EDI software system. Company uses Gotham Insurance, Aetna Insurance and United Insurance.
Review and verify personal information including names, addresses, ages, and other data when reviewing claim submissions.
Review claims which may require direct network contact.
Responsible for contributing to cost containment efforts by validating bills for services rendered, authenticity and reasonable and customary charges.
Responsible for handling disputes, as well as processing corrected and reworked claims.
Manager inboxes for Gotham Insurance, Aetna Insurance and United Insurance.
Adhere to company policies and local, state, and federal guidelines when facilitating claims processing.
Other duties, as deemed necessary in the role as a claim’s processor.
Qualifications:
High School diploma, GED, or equivalent to 1+ years of customer service experience OR experience in a medical office, health care Call Center or Office setting analyzing and solving customer problems.
MUST HAVE
prior work experience opening cases and qualifying claims/bills for payment, checking for coverage and applying co-pay's deductible, and.checking coinsurance
MUST HAVE
fluency in basic computer systems like Microsoft Office, and/or risk assessment software.
Should have some experience in fielding phone calls and emails in a high-volume setting such as in a customer service representative position.
Must have strong critical thinking, problem-solving, decision-making, and communication skills.
Claims Processor
for a company in Foothill Ranch that serves medical providers, clients and patients.
This is a Temporary to Hire opportunity, pay rate $20-23/hr, depending on experience. Full-time, Monday - Friday, 7:00 AM - 4:00 PM, with a 1 hour unpaid lunch. This is 100% ON-SITE position. Ideal candidate will be organized and detail-oriented. Position offers mentorship and advancement opportunities.
Essential Responsibilities:
In the Claims Processor role, not only are you responsible for qualifying claims/bills for payment, you will also need to check for coverage and apply co-pay's deductible, and.check coinsurance
You will need to create cases and assist with incoming calls, as well as working closely with other departments
Import claims received into specified cases. Claims are received through EDI software system. Company uses Gotham Insurance, Aetna Insurance and United Insurance.
Review and verify personal information including names, addresses, ages, and other data when reviewing claim submissions.
Review claims which may require direct network contact.
Responsible for contributing to cost containment efforts by validating bills for services rendered, authenticity and reasonable and customary charges.
Responsible for handling disputes, as well as processing corrected and reworked claims.
Manager inboxes for Gotham Insurance, Aetna Insurance and United Insurance.
Adhere to company policies and local, state, and federal guidelines when facilitating claims processing.
Other duties, as deemed necessary in the role as a claim’s processor.
Qualifications:
High School diploma, GED, or equivalent to 1+ years of customer service experience OR experience in a medical office, health care Call Center or Office setting analyzing and solving customer problems.
MUST HAVE
prior work experience opening cases and qualifying claims/bills for payment, checking for coverage and applying co-pay's deductible, and.checking coinsurance
MUST HAVE
fluency in basic computer systems like Microsoft Office, and/or risk assessment software.
Should have some experience in fielding phone calls and emails in a high-volume setting such as in a customer service representative position.
Must have strong critical thinking, problem-solving, decision-making, and communication skills.