Claims Examiner II
📋 Role Overview & Responsibilities
ESSENTIAL JOB FUNCTIONS:Adjudicates complex professional and institutional claims.Responsible for meeting performance measurement standards for productivity and accuracy.Adjudication of claims adjustment.Follow all appropriate Federal and State regulatory requirements and guidelines applicable to HealthPlan operations or as documented in company policies and procedures.Maintain required levels of production and quality standards as established by management.Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.Maintains regular and consistent attendance.Adheres to Compliance Plan and HIPAA regulations. MARGINAL JOB FUNCTIONS:Takes on special projects as needed.Performs other duties as assigned.
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This position is located in Pasadena, CA with potential relocation and sponsorship assistance depending on candidate qualifications.
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