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5 Claims Examiners/MEDICAL/HEALTHCARE SECTOR

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POST DATE 9/12/2016
END DATE 10/24/2016

ACT-1 Los Angeles, CA

Company
ACT-1
Job Classification
Full Time
Company Ref #
23179091.1489
AJE Ref #
576147674
Location
Los Angeles, CA
Job Type
Regular
Required Licenses/Certifications
df-aj

JOB DESCRIPTION

APPLY
Seeking 5 Claims Examiners due to massive expansion. As the trusted individual in the role, the position 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, including complex claims - Monitoring itemized billings for excessive charges, duplications, unbundling, and medical coding - Determining prior authorization/precertification of services paid via system and/or health services - Requesting and reviewing medical records as needed for basic information to validate billing information - 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 department to meet regulatory compliance. For immediate & confidential consideration, please forward your resume through a Microsoft word document, and contact Gladys Beltran at the Act-1 Los Angeles office. We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

Job Experience:

Individuals that have a demonstrated track record within the medical/healthcare sector are highly encouraged to apply. Actively interviewing for this great career role.