Medical Claims Examiner

100% ON SITE IN WHITTIER, CA

MUST HAVE: Minimum of 2 years claims Examinator ADJUDICATION-related experience in ambulatory, acute care hospital, HMO, or IPA environment payment accuracy guidelines for commercial, senior , and Medi-Cal claims,

PAY: $25-$27

FOR IMMEDIATE CONSIDERATION, PLEASE SEND ME YOUR MOST UPDATED RESUME TO THE FOLLOWING EMAIL: JOHMARTIN@TEKSYSTEMS .COM

SUBJECT LINE TO READ: "Medical Claims Examiner " Updated Resume

Job Description

High school graduate or equivalent required Minimum of 2 years claims ADJUDICATION-related experience

in ambulatory, acute care hospital, HMO, or IPA environment

Knowledge of payment methodologies for Professional (MD),

Hospital, Skilled Nursing Facilities, and Ancillary Services

Knowledge and understanding of timeliness and payment

accuracy guidelines for commercial, senior, and Medi-Cal claims

Knowledge of compliance issues as they relate to claims

processing

Experience in interpreting provider contract reimbursement

terms desirable

Ability to identify non-contracted providers for Letter of

Agreement consideration

Claims Adjudicator Overview

Claimsadjudication is the process of paying or denying claims after they are

evaluated.

Claims adjudicators are the ones responsible for determining the

amount of money that should be paid to the insurance policy owners, as well as

deciding if the claim should be denied or negotiated.

The typical workflow of a claims adjudicator involves many

reviews, namely the initial process review, automatic review, and manual

review, which are then followed by payment determination and the payment

itself. During this process, a claims adjudicator examines claim documents,

investigates the claim, and reviews the policy of the insured before making a

decision.

Typically, you need to have a bachelor's degree in

accounting, human resources, or a similar field in order to qualify for this

role. You may also need to have specialized training or experience in a

specific area, such as in the case of health insurance claims adjudicators.

Nevertheless, employers may hire fresh graduates for this entry-level role,

given that they have excellent communication and analytical skills.

What Does A Claims Adjudicator Do?

Claims adjudicators determine the amount of money an

insurance policy owner is entitled to receive. Other names they are known for

are claims adjusters and medical bill advocates. They investigate the claims

filed and decide to deny, pay, or negotiate a settlement with the policyholder

themselves or their representatives. The insurance companies that hire them

provide insurances for property, casualty, and liability. To do their job well,

they should be organized and understand how the insurance industry works.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.