Claims Examiner
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At a glance
Job overview
US Tech Solutions is hiring a Claims Examiner. The Claims Examiner will review, adjudicate, and process medical claims for HMO patients, working closely with affiliated medical groups and hospitals. This role involves evaluating provider reimbursement terms, flagging non-contracted providers, and ensuring claims are processed accurately and timely according to policy guidelines.
Key focus areas include Review, adjudicate, and process medical claims for HMO patients, Work closely with affiliated medical groups and hospitals, and Evaluate provider reimbursement terms and flag non-contracted providers.
Important skills include Claims Reimbursement Knowledge, DOFR, Processing Lab Claims, UB-92, HCFA-1500, and Provider Contracts.
Skills & qualifications
Skills
Qualifications
Full job description
Whittier, CA
Contract
Duration: 3+ months contract
Responsibilities:
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Review, adjudicate, and process medical claims for HMO patients
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Work closely with affiliated medical groups and hospitals
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Evaluate provider reimbursement terms and flag non-contracted providers
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Ensure claims are processed accurately and timely per policy guidelines
Experience:
2+ years of experience in claims adjudication (HMO, IPA, or hospital environment)
Skills:
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Claims reimbursement knowledge
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Experience working with DOFR (Division of Financial Responsibility)
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Hands-on experience processing lab claims
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Familiar with UB-92 and HCFA-1500 forms
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Understanding of provider contracts, Medi-Cal, commercial, and senior plan claims
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Strong knowledge of timeliness, payment accuracy, and compliance standards
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Basic computer and data entry skills
Education:
High school diploma, GED, or higher
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity,
national origin, disability, or status as a protected veteran.
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