Do you have an interest in providing timely, accurate and cost effective delivery of claim services to health care providers and the public? If so, bring your knowledge of medical terminology, human anatomy and your ability to authenticate, adjudicate and facilitate payment of claims for health care benefits to our team!
- Use your research skills to assess claims and analyze payment irregularities within strict deadlines.
- Respond to inquiries.
- Initiate payments, adjustments or recoveries.
- Provide service to medical providers and the public.
- Deal with confidential and sensitive medical and personal information.
- Demonstrated knowledge of medical terminology and human anatomy to read and understand operative and emergency reports.
- Proven ability to apply discretion and judgement to confirm eligibility for programs, determine when to escalate contentious issues/claims and adjudicate payment as applicable.
- Ability to determine appropriate payment.
- Proven ability to understand, interpret and apply policies, work within guidelines, procedures and legislation to process claims and protect information and determine its disclosure.
- Ability to organize and manage own workload, process a high volume of claims and inquiries within strict timeframes.
- Ability to evaluate and adjudicate stakeholder claims.
Vacancy Type: Full Time
Job Location: Hamilton, CA
Application Deadline: N/A