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Form of workSalary Range: $22.0700 - $33.9100 /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education.
Primary Duties and Responsibilities
The Claims Examiner is responsible for the accurate and timely administration of claim payments for services rendered by all healthcare providers (professional, facility, ancillary). This role processes medical claims timely and accurately. Interprets and administers member benefits, contract terms with medical providers, utilizes various fee schedules and payment terms and health plans/Division of Financial Responsibility. Review pending claims and resolve unclean or contested claims. Administer timely filing guidelines as well as regulatory and industry guidelines. Informs claims management team of issues and trends in the claim adjudication process. Supports the claim team in improvement initiatives. Performs other duties as assigned.
Additionally, the Sr. Claims Examiner specializes in processing complex claim types and contracts that require careful review and higher degree of accuracy. Assists in resolving escalated issues from provider customer service, member services, health plan, and other customers including making and answering phone calls to providers/billing offices when necessary based on team guidelines. Assist in completing special projects related to provider and plan JOCs, system upgrades, etc. Mentor on the team that leads aspects of training function.
Education and Experience
High School Diploma or equivalent
5 years of experience in a medical claims processing environment
Knowledge of HMO/managed care regulatory guidelines (Title 22, AB1455, AB1203, AB1324, AB72, CMS guidelines, COB guidelines, etc.)
Microsoft Word, Excel, Typing/Data Entry
Preferred:
Experience with Epic Tapestry system
Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.
Primary Duties and Responsibilities
The Claims Examiner is responsible for the accurate and timely administration of claim payments for services rendered by all healthcare providers (professional, facility, ancillary). This role processes medical claims timely and accurately. Interprets and administers member benefits, contract terms with medical providers, utilizes various fee schedules and payment terms and health plans/Division of Financial Responsibility. Review pending claims and resolve unclean or contested claims. Administer timely filing guidelines as well as regulatory and industry guidelines. Informs claims management team of issues and trends in the claim adjudication process. Supports the claim team in improvement initiatives. Performs other duties as assigned.
Additionally, the Sr. Claims Examiner specializes in processing complex claim types and contracts that require careful review and higher degree of accuracy. Assists in resolving escalated issues from provider customer service, member services, health plan, and other customers including making and answering phone calls to providers/billing offices when necessary based on team guidelines. Assist in completing special projects related to provider and plan JOCs, system upgrades, etc. Mentor on the team that leads aspects of training function.
Education and Experience
High School Diploma or equivalent
5 years of experience in a medical claims processing environment
Knowledge of HMO/managed care regulatory guidelines (Title 22, AB1455, AB1203, AB1324, AB72, CMS guidelines, COB guidelines, etc.)
Microsoft Word, Excel, Typing/Data Entry
Preferred:
Experience with Epic Tapestry system
Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.
