Christmas Lumber Company, Inc.
Claims Examiner
Christmas Lumber Company, Inc., Los Angeles, California, United States, 90079
Position Description
The Claims Examiner II is responsible for the accurate and timely processing of direct contract and delegated claims per regulatory and contractual guidelines, which includes:Processing claims for all lines of business.Processing all claims types as needed.Monitoring itemized billings for excessive charges and duplications.Ensuring that all work meets quality guidelines and is performed within acceptable time frames.Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated.Meeting and exceeding performance measurements for Claim Examiners as required by the department to meet regulatory compliance.Assisting management with onsite training as needed.Assisting Claims Examiner III as needed for special requests.Skills Required
Ability to:Operate PC-based software programs or automated database management systems.Communicate effectively with strong analytical and problem-solving skills.Self-manage in a fast-paced, detail-oriented environment.Understand medical terminology, standard claims forms, and physician billing coding.Read and interpret contracts and standard reference materials (PDR, CPT, ICD-10, and HCPCS).Possess complete product and Coordination Of Benefits (COB) knowledge.Utilize Microsoft Word and Excel at a moderate level.Experience Required
At least 0-2 years of healthcare claims processing experience in a managed care environment. Previous Medi-Cal or Medicare claims processing experience and knowledge of AB1455 regulations.Education Required
High School DiplomaEducation Preferred
Associate’s DegreeApply Now
Please send your resume and any additional information to our recruitment team at
recruitment@teknita.com .
#J-18808-Ljbffr
The Claims Examiner II is responsible for the accurate and timely processing of direct contract and delegated claims per regulatory and contractual guidelines, which includes:Processing claims for all lines of business.Processing all claims types as needed.Monitoring itemized billings for excessive charges and duplications.Ensuring that all work meets quality guidelines and is performed within acceptable time frames.Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated.Meeting and exceeding performance measurements for Claim Examiners as required by the department to meet regulatory compliance.Assisting management with onsite training as needed.Assisting Claims Examiner III as needed for special requests.Skills Required
Ability to:Operate PC-based software programs or automated database management systems.Communicate effectively with strong analytical and problem-solving skills.Self-manage in a fast-paced, detail-oriented environment.Understand medical terminology, standard claims forms, and physician billing coding.Read and interpret contracts and standard reference materials (PDR, CPT, ICD-10, and HCPCS).Possess complete product and Coordination Of Benefits (COB) knowledge.Utilize Microsoft Word and Excel at a moderate level.Experience Required
At least 0-2 years of healthcare claims processing experience in a managed care environment. Previous Medi-Cal or Medicare claims processing experience and knowledge of AB1455 regulations.Education Required
High School DiplomaEducation Preferred
Associate’s DegreeApply Now
Please send your resume and any additional information to our recruitment team at
recruitment@teknita.com .
#J-18808-Ljbffr