Claims Examiner IIi - (US-CA-Long Beach - 90899)

Minimum Education: None
Job Type: Full Time
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Responsibilities: Claims Processing  of complex claims and adjudication, and claims research when necessary.  Must meet and/or exceed qualitative and quantitative production standards.  Provides informational resource for employees, assist in training new staff, handle difficult claims.  Requirements: Education:High School Diploma or G.E.D REQUIREDSome college education preferred.Experience:5-6 Years experience in claims adjudication.Excellent verbal and written skillsExperience in processing all types of medical claims, e.g. HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated claims, COB and DRG/RCC pricing.Additional Skills and Knowledge: Must know computerized claims processing systems.Data entry and 10-key skills by touch and sight.Knowledge of CPT/HCPC and ICD9 coding, procedures and guidelines.Comprehensive medical terminology and knowledge.Efficiency and accuracy of claim payments during processing and adjudication.  Analytical ability.Quality Standard-Must meet and Maintain quality standard for position.Claims Adjudication-Must meet and consistently maintain production standards .Supports all department initiatives in improving overall efficiency.Teamwork-Rating is based upon individual contribution to both the group and the goals of the group.  This area will be rated using the outcome of team goals.Defect reduction via pro-active in identifying error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues.Overall performance accountability (attendance, communication, flexibility, adaptability, interpersonal skills, teamwork and cooperation).Molina Healthcare offers competitive benefits and compensation package.

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