PIH Health · 2 days ago

Senior Claims Examiner

Whittier, CA

Full-time

Onsite

Senior Level

$21/hr - $33.78/hr

2+ years exp

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Health Care

Insider Connection @PIH Health

Discover valuable connections within the company who might provide insights and potential referrals, giving your job application an inside edge.

Responsibilities

Administer health plan contracts by processing medical claims efficiently, cost-effectively, and in a timely manner meeting all required guidelines.

Perform adjustments as necessary, including handling Third-Party Liability requests, Out-of-pocket Maximum requests, EDI rejects, and other special projects.

Qualification

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Computer Skills10-Key SkillsMedical Terminology KnowledgeCPT/RBRVS/ICD-9 Codes Knowledge HMO & Capitation Concepts Medicare GuidelinesMedical Claims Processing Experience Communication Work IndependentlyProblem-Solving