Claims Examiner I

Claims Examiner I

W2 Contract

Salary Range: $47,800 - $52,000 per year

Location: South San Francisco, CA - Remote Role

Note: This role is a remote position with occasional onsite meetings in South San Francisco.

Duties and Responsibilities:

Research rejected claims as necessary and re-adjudicated them when resolved.

Perform claim entry of all standard claim forms.

Correspond as required to resolve rejected claims.

Review reports, verify accurate data, and make corrections as appropriate.

Review fewer complex edits to determine the appropriate handling, including paying, denying, or pending for analyst review.

Use Policies and Procedures, Claims Manual, and other resources to complete weekly reviews.

Assist in creating and developing memos, processes, and tools when needed.

Monitor own performance via production and auditing tools and reports.

Attend team, company, one-on-one meetings, and other functions.

Communicate issues with the Manager and Claims Auditor; make recommendations on claims issues.

Attend onsite meetings as required.

Perform other duties as assigned.

Requirements and Qualifications:

High School diploma, GED, or equivalent required

2+ years of general office experience; claims processing experience preferred.

Knowledge of medical billing and terminology

Understanding of Medi Cal and Medicare program rules and requirements

Experience with claims adjudication processes

Procedure and diagnostic coding experience

Proficiency with personal computers and Microsoft Office Suite (Outlook, Word, Excel, PowerPoint)

Ability to work cooperatively as part of a team and support team decisions

Excellent verbal and written communication skills

Adaptability to changing requirements and priorities

Alpha numeric data entry proficiency

Strong attention to detail

Ability to organize, prioritize, and complete multiple tasks within established timeframes

Ability to maintain accurate records and document relevant information clearly

Ability to exercise sound judgment within the scope of authority

Ability to handle confidential issues with tact and diplomacy

NCCI Edits experience a plus

Desired Skills and Experience

Insurance, claims processing, claims adjudication, medical billing, Medi Cal, Medicare, Microsoft Office

Bayside Solutions, Inc. is not able to sponsor any candidates at this time. Additionally, candidates for this position must qualify as a W2 candidate.

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