Position: Medical Claims Examiner Processor

Company: Benefit & Risk Management Services

Location: 80 Iron Point Circle, Suite 200, Folsom, CA 95630- This is an on-site position- Folsom CA

Pay rate $20.00 - $26.00 DOE

Schedule: 8:30am-5pm; Monday thru Friday

Number of openings: 4

Summary: The Claims Examiner I is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. Processes claims by performing the following duties

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Compares data on claim with internal policy and other company records to ascertain completeness and validity of claim.
• Comprehensive understanding of employee benefits for medical, dental and vision plans.
• Adjudicates medical claims, applies coordination of benefits as outlined in plan guidelines and works with providers to gather the necessary documents to make final payment determination on claims
• Ensures all claims are coded properly.
• Examines Summary Plan Document, claim adjustors' reports or similar claims/precedents to determine extent of coverage and liability.
• Maintains high quality standards to avoid paying claim incorrectly.
• Maintains productivity standards set by Management.
• Refers most questionable claims for investigation to claim examiner II for review and processing.
• Research and resolve paid and denied claims escalations from internal sources and/or TIPS ticketing system when assigned.
• Works from the claims queue manager to process & releases claims for adjudication and payment within 3-5 days of receipt.
• Performs other duties and responsibilities as assigned by Management.

Knowledge, Skills, & Abilities:

• Excellent written and verbal communication skills.
• Strong analytical skills and problem-solving skills.
• Must be dependable and maintain excellent attendance and punctuality
• Must be able to perform data entry operations quickly and accurately.
• Ability to grow with changing demands of the position and the company.
• Strong computer skills, including Word, Excel, and Outlook.
• Successful candidates must have experience processing medical claims for an insurance company or third party administrator
• Must be highly proficient in ICD-10, CPT, and HCPCS codes

Education and/or Experience: Associate's degree (A. A.) or equivalent from two-year college or technical school; Must have 3-5 years employee benefits industry experience or equivalent combination of education and experience.

Language Skills: Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports, meeting notes, project documentation, and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position.

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized or non-standardized situations

Experience/Requirements:

o Must have 3-5 years’ experience in employee benefits industry (Full Cycle Medical Claims Examiner Processor- Adjudicates medical claims, applies coordination of benefits as outlined in plan guidelines and works with providers to gather the necessary documents to make final payment determination on claims etc.)

o Must be highly proficient in ICD-10, CPT, and HCPCS codes.

o Background (BRMS to run) and work references (Manger/Supervisor) required

o They will have to take the following tests before they meet with me and I will need the results: Data/Typing (30 wpm or better),Basic computer/Internet navigation, Outlook, Desktop (80% or better)

o They will need to take a Claims Examiner test the day of their in-person interview with the hiring manager (If they get to that step)

Benefits:

Medical, Dental, Vision- eligibility is 30 days from start date. ****We pay for the employee’s benefits, if they have dependents, they will have to pay for dependents****

401k-BRMS matches 100% up to 3%, eligibility is 30 days from start date

10 paid Holidays

PTO= they accrue 120 hours the first year

Sick time: 40 hours after they have worked 90 days

If you are interested, please reach out to Arely !626272515O!

Job Type: Full-time

Pay: $20.00 - $26.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Office

Experience:

• working for a TPA or an insurance company: 3 years (Required)
• ADJUDICATING CLAIMS: 3 years (Required)
• Full cycle medical claim processing: 3 years (Required)
• applying the CPT code and/ or DX codes to process the claims: 3 years (Required)

Ability to Relocate:

• Folsom, CA 95630: Relocate before starting work (Required)

Work Location: In person