Claims Examiner Job

CLAIMS EXAMINER needed for a CONTRACT opportunity with Yoh's client located in San Francisco, CA.

THE BIG PICTURE - TOP SKILLS YOU SHOULD POSSESS:

- Experience within Managed Care
- Knowledge of Medi-Cal guidelines

WHAT YOU'LL BE DOING:

- Keep the department's claim inventory current and clear edit queues by process claims according to verification of eligibility, interpretation of program benefits, and provider contracts to include manual pricing
- Correctly match authorizations to claims
- Coordinate benefits/other health coverage
- Utilize the QNXT claims processing module in an effective and efficient manner to process claims
- Review claims for necessity, limitations and exclusions based on claims policies and procedures
- Review claims for missing or incomplete information; request additional information needed to complete adjudication of claims

WHAT YOU NEED TO BRING TO THE TABLE:

- A high school diploma with a college degree preferred
- A minimum of 2 years prior work experience in claims operations environment and health care insurance business, preferably with focus on Medi-Cal claims
- Hands-on working knowledge and background using claims processing system(s)
- Knowledge of CPT/HCPCS, ICD-9 coding, medical terminology and managed care principles
- Excellent ability to produce accurate work in a fast-paced environment
- Effective interpersonal and professional communication skills

WHAT'S IN IT FOR YOU?

We welcome you to be a part of the largest global staffing companies to meet your career aspirations. Yoh's network of client companies has been employing professionals like you for over 65 years in the U.S., UK and Canada.

- Medical, Dental & Vision Benefits
- 401K Retirement Saving Plan
- Life & Disability Insurance
- Direct Deposit & weekly epayroll
- Employee Discount Program's
- Referral Bonus Program's

WHAT ARE YOU WAITING FOR? APPLY NOW!

RECRUITER: Annie Gill

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Contact us if you are an individual with a disability and require accommodation in the application process.

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