California Licensed Claims Processor

Job Summary

A company is looking for a Health Insurance Claim Processor.

Key Responsibilities

• Review, verify, and process insurance claims in accordance with company policies
• Analyze claim documents and medical records to determine eligibility and process claims
• Communicate with members, healthcare providers, and internal partners to resolve claims and gather information

Required Qualifications

• Minimum of 3 years of experience in the healthcare domain and claims processing
• Experience with Medicare and Medicaid claims processing
• Knowledge of ICD-9 & 10 coding and CPT codes
• Experience as a Claim Examiner Level III for at least 3 years
• Basic knowledge of claims processing forms such as UB04 & CMS1500