Medical Claims Processor

TEKsystems • Bakersfield, CA

4d • $22 - $22 • Remote

About The Position

Deny inappropriate claims following policy guidelines. Prepare claims that must be routed to other departments for further review.
Review difficult claims with guidance from Claims Supervisor.
Responsible for identifying billing errors and possible fraudulent claims submissions.
Obtain eligibility verification and other health insurance coverage by Internet or POS.
Responsible for correct manual calculation of benefits when applicable.
Responsible for identifying possible CCS eligible claims for further investigation.
Report overpayment refund requests on SharePoint log
Maintain productivity and quality in accordance with established guideline.
Perform other job-related duties as required.
Regular Predictable attendance.
Adheres to all company policies and procedures relative to employment and job responsibilities.

Requirements

• High School Diploma from an accredited school or equivalent.
• Minimum of one (1) year medical Claims Examiner processing experience.
• Individual must have good organizational skills and the ability to make good decisions.
• Experience with QNXT
• Experience with Medi-Cal Claims

Responsibilities

• Deny inappropriate claims following policy guidelines.
• Prepare claims that must be routed to other departments for further review.
• Review difficult claims with guidance from Claims Supervisor.
• Responsible for identifying billing errors and possible fraudulent claims submissions.
• Obtain eligibility verification and other health insurance coverage by Internet or POS.
• Responsible for correct manual calculation of benefits when applicable.
• Responsible for identifying possible CCS eligible claims for further investigation.
• Report overpayment refund requests on SharePoint log
• Maintain productivity and quality in accordance with established guideline.
• Perform other job-related duties as required.
• Regular Predictable attendance.
• Adheres to all company policies and procedures relative to employment and job responsibilities.

Benefits

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED