Medical Claims Examiner
Location: Los Angeles
Posted on: October 29, 2024
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Job Description:
If you read this post and have some of these qualifications
please send your resume immediately!
The opportunity is fast moving with a great company looking to
acquire professionals who can contribute and grow with the
company.
Medical Claims Specialist Examiner Job Responsibilities:
Serves medical insurance customers by examining and resolving
medical claims; documenting actions; maintaining quality customer
services; ensuring legal compliance.
Medical Claims Specialist Examiner Job Duties:
?Determines covered medical insurance losses by studying provisions
of policy or certificate.
?Establishes proof of loss by studying medical documentation;
assembling additional information as required from outside sources,
including claimant, physician, employer, hospital, and other
insurance companies; initiating or conducting investigation of
questionable claims.
?Documents medical claims actions by completing forms, reports,
logs, and records.
?Resolves medical claims by approving or denying documentation;
calculating benefit due; initiating payment or composing denial
letter.
?Ensures legal compliance by following company policies,
procedures, guidelines, as well as state and federal insurance
regulations.
?Maintains quality customer services by following customer service
practices; responding to customer inquiries.
?Provides legal support by assembling documentation for settlement
action.
?Protects operations by keeping claims information
confidential.
?Prepares reports by collecting, analyzing, and summarizing
information.
?Updates job knowledge by participating in educational
opportunities; reading professional publications; maintaining
personal networks; participating in professional organizations.
?Accomplishes organization goals by accepting ownership for
accomplishing new and different requests; exploring opportunities
to add value to job accomplishments.
We are an equal employment opportunity employer and will consider
all qualified candidates without regard to disability or protected
veteran status.
Keywords: , Whittier , Medical Claims Examiner, Healthcare , Los Angeles, California
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