Medical Claims Examiner - Los Angeles California

Location: Los Angeles, California
Posted On: 02/03/2025

If you read this post and have some of these qualifications please send your resume immediately!

The opportunity is fast moving with a great company looking to acquire professionals who can contribute and grow with the company.



Medical Claims Specialist Examiner Job Responsibilities:

Serves medical insurance customers by examining and resolving medical claims; documenting actions; maintaining quality customer services; ensuring legal compliance.





Medical Claims Specialist Examiner Job Duties:

?Determines covered medical insurance losses by studying provisions of policy or certificate.

?Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.

?Documents medical claims actions by completing forms, reports, logs, and records.

?Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.

?Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.

?Maintains quality customer services by following customer service practices; responding to customer inquiries.

?Provides legal support by assembling documentation for settlement action.

?Protects operations by keeping claims information confidential.

?Prepares reports by collecting, analyzing, and summarizing information.

?Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.

?Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status. More...

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