Claims Processor Rep - Cerritos, CA

Able to handle more complex claims.
Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits, and healthcare terminology.
Good working knowledge of claims and products, including the grievance and/or re-consideration process.
Excellent knowledge of the various operations of the organization, products, and services.
Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement.
Researches and analyzes claims issues.
Responds to inquiries, may involve customer/client contact.
Must meet production and quality standards.
Claims processing accuracy of 99% and above and the ability to process 120 or more claims per day.
Proficient in claims adjudication and knowledge of Medicare.

EDUCATION/EXPERIENCE:
Requires a HS diploma or equivalent; 2-5 years of claims processing experience; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.); or any combination of education and experience, which would provide an equivalent background.
Claims adjudication experience a must.
Experience with Medicaid, Medicare and/or Medi-Cal claims highly preferred.
Knowledge of contracts, CPT, HCPCs, ICD-9/10 and Medicare billing guidelines.
High School diploma or any combination of education and experience, which would provide an equivalent background.

SKILLS:
Ability to effectively apply knowledge gained in training.
Detail oriented. Good PC skills including MS Word and MS Excel.
Good oral and written communication skills.
Ability to identify problems and logically research with minimum assistance to locate answer through appropriate reference materials.
Good time management skills.
Maintains positive and cooperative working relationships with co-workers and other associates

All your information will be kept confidential according to EEO guidelines.