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The Position.
We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits based on established criteria and provider contracts. Experience in adjudication of Commercial, Medicare Advantage, and Medi-Cal claims will make you a great candidate, along with experience or familiarity with Healthcare Service industry, Independent Physician Associates (IPAs), and/or have experience in a Managed Care/Service Organization (MSO) or Health Plan background.
The Specs.
The Duties.
*Please note that the duties and responsibilities outlined above are summarized and may not encompass all tasks associated with the position. The nature of the role may require adaptation to changing circumstances and additional responsibilities not explicitly mentioned here. The organization reserves the right to modify, interpret, or supplement the job duties as needed.
THE COMPANY.
Innovative Management Systems is a management services company focused on finding innovative ways to ensure regulatory compliance, customer services, provider experience, and measurable outcomes in the healthcare industry. Through our ever-evolving data analytics platform, we strive to improve overall medical spending, HEDIS, and STAR measures through a collaborative effort of education, reporting and workflow management. Come be part of the team that helps to improve quality of care, reduce administrative burden, and achieve greatness through creative thinking and educated calculated risks. Be the change in healthcare everyone talks about, but few people achieve. We value our team's opinions and new ways of getting the job done and are looking for self-starters with fresh ideas, ready to help pave the way to a better tomorrow.
We are an Equal Opportunity Employer and seek diversity in our workforce. We are also an E-Verify Employer , you can learn more about E-Verify program and your rights and responsibilities here: Learn More About E-Verify.
Requirements:What You Need.
Compensation details: 20-24 Hourly Wage
PI0455ab6b430b-31181-29101014
Full Time
$52k-66k (estimate)
05/01/2024
05/20/2024
imsmso.com
Los Angeles, CA
The following is the career advancement route for Claims Examiner positions, which can be used as a reference in future career path planning. As a Claims Examiner, it can be promoted into senior positions as a Claims Examiner III that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Claims Examiner. You can explore the career advancement for a Claims Examiner below and select your interested title to get hiring information.
If you are interested in becoming a Claims Examiner, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Claims Examiner for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Claims Examiner job description and responsibilities
Most medical claims examiners deal with paperwork on a daily basis and they are expected to work on multiple claims per day.
04/03/2022: Springfield, MA
Each claim often comes with supporting documents such as medical records and hospital bills and examiners need to look over each file carefully.
03/08/2022: Manchester, NH
Claims examiners are responsible for approving or rejecting claims or arranging settlements.
01/25/2022: Santa Fe, NM
Examiners may review medical bills or accident reports and they may consult specialists.
01/30/2022: Santa Barbara, CA
The Claims Examiner maintains a full case load of professional liability claims.
01/24/2022: Monroe, LA
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Claims Examiner jobs
Keep reading to learn more about a claims examiner role.
03/28/2022: Oklahoma City, OK
Candidates should know that having a critical thinking and outstanding decision-making give examiners the logic and reasoning to evaluate and resolve claims.
04/05/2022: Tulsa, OK
Most employers require or strongly prefer medical claims examiners that have some medical background such as a postsecondary diploma.
03/11/2022: San Antonio, TX
To determine whether a claim should be rewarded, an examiner must be aware of the red flags associated with fraudulent claims and possess detailed analysis skills.
01/30/2022: Bellingham, WA
To begin a career as a medical claims examiner, one must first learn certain knowledge and skills that will help them execute the duties of the job.
02/17/2022: Lawton, OK
Step 3: View the best colleges and universities for Claims Examiner.