Claims Examiner

Maxonic maintains a close and long-term relationship with our direct client. In support of their needs, we are looking for a Claims Examiner
.

• Must have listed claims reimbursement experience
• Must have DOFR
• Must have processed lab claims
• 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER EDUCATION

The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.

• High school graduate or equivalent required. Must have physical proof on hand if background check is unable to verify your education background.
• Minimum of 2 years claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environment
• Knowledge of payment methodologies for:
  Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
• Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims
• Knowledge of compliance issues as they relate to claims processing
• Ability to identify non-contracted providers for Letter of Agreement consideration
• Training on basic office automation and managed care computer systems.

Since 2002 Maxonic has been at the forefront of connecting candidate strengths to client challenges. Our award winning, dedicated team of recruiting professionals are specialized by technology, are great listeners, and will seek to find a position that meets the long-term career needs of our candidates. We take pride in the over 10,000 candidates that we have placed, and the repeat business that we earn from our satisfied clients.

Please apply with your most current resume. Feel free to contact Jaspreet Singh ( / ) for more details.