Claims Examiner II/III

Job Description

We are looking for a Claims Examiner II/III to join our team at Innovative Management Systems Incorporated. This position requires a deep understanding of Medicare claims processing in managed care organizations, MSOs, IPAs, and health plans. The ideal candidate will be responsible for reviewing, researching, and analyzing claims, making benefit determinations, and identifying and resolving claim issues. Additionally, the position entails processing various types of claims accurately and efficiently, adhering to quality and production standards.

Position Specs

• Non-Exempt, Full-Time
• Benefits-Eligible: PTO, PSL, Holidays, 401(k), Flexible Spending Account, Work/Life Balance, Unpaid Time Off
• Schedule: Monday - Friday; flexible hours between 8:30 am - 5:30 pm
• Salary Range: $24-$37 per hour depending on experience

Responsibilities

• Adjudicate claims in compliance with financial guidelines
• Identify root causes of claim issues and collaborate with stakeholders for resolution
• Interpret contracts, fee schedules, and eligibility criteria accurately
• Generate reports on claims-related matters and contribute to process efficiency

Requirements

• High School diploma with 3+ years of claims processing experience in managed care
• Knowledge of Medicare, Medi-Cal, HCFA 1500 forms, CPT and ICD codes
• Strong communication, organization, and multitasking skills
• Proficiency in Microsoft Office applications

Skills

• Understanding of financial risk division
• Effective communication and customer service abilities
• Proactive, independent work ethic with attention to detail
• Ability to maintain confidentiality and adhere to HIPAA

Compensation

$24-$37 Hourly Wage