Senior Claims Specialist
Where
- Torrance, CA
What you'll be doing
- The hiring person is responsible for processing, auditing, and adjusting all professional and facility medical claims, appeals and prepayment audits. Answers incoming telephone inquiries, and accurately and thoroughly documents problems and resolutions. Troubleshoots claims that have been identified as needing additional work in the areas of eligibility, referral authorization and contracting or provider set-up. Trains and assists other analysts with problem claims and escalated telephone calls. Performs other duties as assigned.
What your background should be
- Over 5 years and up to and including 7 years of experience in an indemnity and / or HMO setting processing, auditing or adjusting professional claims. Computer literate. Knowledge of Microsoft Office products. Individual must be reliable, dependable, and punctual. Excellent customer service and telephone skills. Excellent verbal and written communication skills. Ability to work in an environment with fluctuating workloads. Ability to solve problems systematically, using sound business judgment. Ability to make decisions with every call and handle escalated issues. Ability to make decisions regarding escalation of referrals to care management. Familiarity with ICD-9 and CPT codes. Knowledge of all types of professional claims. Ability to research and verify claims payment issues. Knowledge of compliance related to the processing of claims. Knowledge of medical terminology and pricing options. Knowledge of different sources of authorization documentation.
Required Schooling / Training
- High school diploma, G.E.D. or equivalent
Who is the client company
- Concern about hospital and healthcare services.
- If you are interested in this position, send your resume to apply@kochdavis.com
