Medical Claims Examiner

Job Description

Southern California United Food & Commercial Workers Unions & Food Employers Joint Benefit Funds Administration, LLC (The Funds) were created more than 40 years ago as a result of collective bargaining between the Southern California Retail Food Employers and the Southern California UFCW Union Locals. The Funds serve in excess of 100,000 participants! There are two Funds, the Pension Fund and the Benefit Fund--through which member retirement and health and welfare benefits are provided.

The Funds Office is currently searching for a supportive Medical Claims Examiner, to assist with Medicaid Claims. In this member facing role, you will be responsible for answering telephonic, email and walk-in requests from members regarding their medical claims. This position is subject to Collective Bargaining.

General Responsibilities:

1. Handle all general telephone and walk-in inquires including but not limited to status, complaints, eligibility, benefits, etc.

2. Working knowledge of CPT/HCPC and ICD-9/ICD-10 codes and guidelines.

3. Adjudicate routine medical claims and all associated tasks in accordance with the Plan, regulatory and contractual guidelines.

4. Maintain current department knowledge of plan documents, summaries of plan provisions and other plan materials.

5. Meet or exceed established department production standards on a weekly, monthly, quarterly and annual basis.

6. Proactively identify opportunities for improvement.

7. Actively participant in system testing when needed.

8. Handle all duties and assignments in a timely manner.

9. Perform other job related duties/special projects as assigned.

Qualifications:

· High School diploma or GED required

· 2+ years of experience as a Medical Claims Adjuster

· MS Office (Excel, Word and Outlook) proficiency required

· Knowledge of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS), Medical Terminology

· Familiar with International Classification of Diseases (ICD) ICD-9/ICD-10 codes and guidelines

· PPO claims processing experience, including prior experience in WGS processing system

· Customer service experience, with the ability to build rapport with Plan participants, team members and other employees of the Fund

Bilingual in English/Spanish preferred

The Funds is an equal employment opportunity employer and no candidate for employment will be rejected on the basis of race, color, religion, national origin, age, marital status, or sex. Candidates with physical impairments or limitations will be considered to the extent it can be reasonably demonstrated that the duties and responsibilities can be effectively performed without endangering the individual, colleagues or surroundings.

The Funds offers exceptional benefit packages that includes a 401(K) plan, pension plan, vacation, holiday, education reimbursement and much more!Company Description

The Southern California United Food & Commercial Workers Unions and Joint Benefit Trust Funds (UFCW) is located in Cypress, California. We serve more than 100,000 collective bargaining employees that serve in the grocery stores throughout Southern California. UFCW provides medical, dental, vision and pension benefits for the grocery workers. We take pride in supporting the valuable grocery store employees as they serve customers throughout the region.