Plans examiner serp_jobs.h1.location_city
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Plans examiner • huntington beach ca
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Orange, CA is a premier healthcare provider specializing in Medicare and HMO services.With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize acc...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected.
We invite you to grow your c...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
By joining Sedgwick, you'll be part of something truly meaningful.It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected.
We invite you to grow your c...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Join a team that puts its People First! Since 1889, First American (NYSE : FAF) has held an unwavering belief in its people.
They are passionate about what they do, and we are equally passionate abou...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
A company is looking for a Title Examiner to handle title work and examinations for multiple states.Key Responsibilities Handle title work and compile, research, and present title commitments bas...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Remote Residential Title Examiner.Insight Global is looking for a Remote Residential Title Examiner to work at an industry-leading title company.
This employee will be responsible for searching publ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Remote Commercial Title Examiner At First American.Join a team that puts its People First! First American's National Production Services division provides global title and escrow production support...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Provide administrative support throughout the contracting process.Perform duties to ensure and maintain the integrity of BMR Partners and contract templates and the integrity of the contract files....serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Join a team that puts its People First! First American's National Production Services division provides global title and escrow production support across all channels within First American Title in...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Manager's Note : Workers Compensation Claims Examiner.Preferred SIP Certification Medical facilities.PRIMARY PURPOSE : To analyze complex or technically difficult workers' compensation claims to dete...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Workers’ Compensation California.Next step in progression could include Lead Senior Claims Examiner or Claims Supervisor.
Explore the Athens Administrators difference : We have been dynamic, innovati...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Only qualified Workers' Compensation candidates located in California are eligible to be considered for this role • • •.Candidates must be located in the state of California.High School Diploma or equ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Center of Medicaid and Medicare Services (CMS) and a state license with the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan.
We are committed to the idea that he...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
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Claims Examiner I
Astiva Health, IncOrange County, CA, United Statesserp_jobs.job_card.full_time
Liability Claims Examiner - Auto & GL
Sedgwick Claims Management Services, Inc.Orange, CA, United Statesserp_jobs.job_card.full_time
Liability Claims Examiner - Auto & GL
SedgwickOrange, CAserp_jobs.job_card.full_time
Senior Title Examiner and Project Coordinator (Remote)
95-2566122 First American Title Insurance Co1 First American Way, Santa Ana, CA 92707serp_jobs.filters.remote
serp_jobs.job_card.full_time
Title Examiner
VirtualVocationsCosta Mesa, California, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Remote Residential Title Examiner (FL)
Insight GlobalSanta Ana, CA, USserp_jobs.filters.remote
serp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Ohio Commercial Title Examiner (Remote)
Remote StaffingSanta Ana, CA, USserp_jobs.filters.remote
serp_jobs.job_card.full_time
Healthcare Plans Contract Specialist (Hybrid Position)
Specialty Care RxOrange, CA, USserp_jobs.job_card.full_time
Sr. CA Commercial Title Examiner (Remote)
First AmericanUSA, California, Santa Anaserp_jobs.filters.remote
serp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Claims Examiner - Workers Compensation
StaffingOrange, CA, USserp_jobs.job_card.full_time
Senior Claims Examiner
ATHENS ADMINISTRATORSOrange, CAserp_jobs.job_card.full_time
Claims Examiner - Workers Compensation
Rose InternationalOrange, CA, USAserp_jobs.job_card.full_time
Claims Examiner III
Verda Healthcare IncHuntington Beach, CA, USserp_jobs.job_card.full_time
Claims Examiner I
Astiva Health, IncOrange County, CA, United Statesjob_description.job_card.variable_days_ago
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- serp_jobs.job_card.full_time
job_description.job_card.job_descriptionGood knowledge of CPT / HCPCS / ICD-10, and Revenue Codes, including modifiers. Assist customer service as needed to assist in claims resolution on calls from providers. Research authorizations and properly selects appropriate authorization for services billed. Coordinate with the claims clerks on issues related to the submission and forwarding of claims determined to be financial responsibility of another organization. Coordinate Benefits on claims for which member has another primary coverage Run monthly reports. Review pre and post check run. Regular and consistent attendance Other duties as assigned High School Diploma or GED required. 1 to 3 years of previous experience in a health plan, IPA or medical group. Strong understanding of the benefit process including member services or customer service. Demonstrated proficiency in MS Office (Excel, Word, Outlook, and PowerPoint). Able to navigate difficult situations with empathy, discretion, and professionalism. Strong understanding of Senior Medicare Advantage Health plans. Able to explain member benefits, answer questions and concerns using a “Customer Service First” attitude. Able to live our mission, vision, and values, Bilingual in another language (written and oral) preferred.
About Us : Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.
SUMMARY : Under the direction of the Vice President of Claims, this position is responsible for manual input and adjudication of claims submitted to the health plan. The ideal candidate will need to interpret and utilize capitation contracts, payor matrixes, subscriber benefit plan, and provider contracts; as well as resolving customer service inquiries, status calls, andclaim tracers.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following :
- Data enter paper claims into EZCAP.
- Review and interpret provider contracts to properly adjudicate claims.
- Review and interpret Division of Financial Responsibility (DOFR) for claims processing.
- Perform delegated duties in a timely and efficient manner.
- Verify eligibility and benefits as necessary to properly apply co-pays.
- Understands eligibility, enrollment, and authorization process.
- Knowledge of prompt payment guidelines for clean and unclean claims
- Process claims efficiently and maintains acceptable quality of at least 95% on reviewed claims.
- Meets daily production standards set for the department.
- Prepares claims for medical review and signature review per processing guidelines.
- Identify the correctly received date on claims, with knowledge of all time frames for meeting compliance for all lines of business.
Maintains good working knowledge of system / internet and online tools used to process claims
QUALIFICATION REQUIREMENTS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and / or EXPERIENCE :