Claims Examiner I (TEMP)

General Description

Under close supervision, the Claims Examiner will perform the accurate review, entry and processing of all claims received for payment by HPSM.

Essential Functions:

• Research rejected claims as necessary and re-adjudicate when resolved.
• Correspond as required to resolve rejected claims.
• Review reports, verifying accurate data and making corrections as appropriate.
• Review less complex edits to determine the appropriate handling for each including paying, denying, or pending for Analyst II or III to review.
• Use Policies & Procedures, Claims Manual and other sources in order to complete the required number of weekly reviews required for this position.
• Monitor own performance via production.
• Attend team, company, and one-on-one meetings and other functions.
• Communicate issues with Manager and Claims Auditor; make recommendations on claims issues.

Secondary Functions:

• Attend team, company, and one-on-one meetings and other functions.
• Communicate issues with Manager and Claims Auditor; make recommendations on claims issues.
• Perform other duties as assigned.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply. 

Education and experience

• High School diploma, GED or equivalent required.
• Two (2) years general office experience. Claims processing experience preferred.

Knowledge of:

• Medical billing and terminology.
• Medi-Cal and Medicare programs.
• Procedure and diagnostic coding.
• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint.

Ability to:

• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Communicate effectively, both verbally and in writing.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Perform alpha-numeric data entry proficiently.
• Perform with attention to detail.
• Organize and prioritize daily work, complete multiple tasks within established time frames.
• Communicate effectively, verbally and in writing.
• Maintain accurate records.
• Use clear notes or remarks to document relevant information.
• Exercise good judgment within scope of authority.
• Handle confidential issues with tact and diplomacy.

Salary and benefits

The starting salary range is $20.69 - $26.17 per hour, depending on the candidate’s work experience.

It is HPSM's policy to provide equal employment opportunities for all applicants and employees.  HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law.  HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.