2 Jobs in Aliso Viejo, CA
UST Healthproof is Hiring a Senior Claims Examiner Near Aliso Viejo, CA
We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States.
You AreUST HealthProof is looking for Senior Claims Examiner, reporting to the Claims Team Leader. The Senior Claims Examiner is responsible for the adjudication of healthcare claims utilizing specific policies and procedures. This role is responsible for reviewing data within the claims processing system, to determine if services rendered were appropriate and benefit coverage criteria were met. The Senior Claims Examiner is accountable for reviewing the adjudication system edits to determine whether to pay the claim and/or line item(s).
The Opportunity
- Be responsible for processing assigned claims based on client-specified guidelines or as directed by the team leader.
- Be responsible for meeting productivity targets, financial and procedural accuracy standards as established by management.
- Mentor junior members of the team
- Collaborate with other team members on special projects as assigned by the team leads; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by the team leader.
- Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality.
- Participate in projects assigned by the team leader; these projects may include provider data, authorizations, enrollment, or other activities.
What You Need
- Solid understanding and ability to analyse claim data.
- ICD-10 CPT and HCPCS coding is a plus.
- Knowledge base of physician billing and hospital coding (ICD-10, HCPC, CPT-4), medical terminology, and authorization requirements
- High School degree required.
- 3 – 5 years healthcare claims processing experience
- Willingness to learn new skills.
- Team collaborator
- Strong work ethic
- The ability to adapt quickly to a fast-paced environment.
- A self-starter and quick learner
- Team player with an ability to collaborate.
Role Location: Remote
Compensation Range: $39,520-$43,680
Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits.
What We BelieveWe’re proud to embrace the same values that have shaped UST HealthProof since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion, and to place people at the center of everything we do.
HumilityWe will listen, learn, be empathetic and help selflessly in our interactions with everyone.
HumanityThrough business, we will better the lives of those less fortunate than ourselves.
IntegrityWe honor our commitments and act with responsibility in all our relationships.
Equal Employment Opportunity StatementUST HealthProof is an Equal Opportunity Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.
#Healthproof
#CB
SkillsHRP,SHAREPOINT,SDS
Job Summary
Full Time
$74k-95k (estimate)
05/27/2024
07/15/2024
usthealthproof.com
<25
The job skills required for Senior Claims Examiner include Claim Processing, Diversity and Inclusion, Commitment, CPT, etc. Having related job skills and expertise will give you an advantage when applying to be a Senior Claims Examiner. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Senior Claims Examiner. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Senior Claims Examiner positions, which can be used as a reference in future career path planning. As a Senior 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 Senior Claims Examiner. You can explore the career advancement for a Senior Claims Examiner below and select your interested title to get hiring information.
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