Claims Examiner I

About the Role

• Location: Bakersfield, CA (Onsite)
• Classification: Full-Time
• This position is non-exempt and will be paid on an hourly basis.

Compensation

• Initial pay range: $20.00 - $24.99 per hour.

Position Summary

This position is responsible for timely and accurate entry of medical claim information into various databases. It involves verification of scanned claims in Anesthesia, COB, and Special batches. The system will prompt verification of certain fields for accuracy and completeness.

Key Responsibilities

• Mail Processing:
• Receive, sort claims and supporting documents according to company policy and procedures.
• Identify claims lacking required information.
• Scan, track, and log all daily mail according to departmental policies and procedures.
• Accurately identify and sort provider disputes.
• File Management:
• Perform basic management of electronic files (print, copy, scan, transfer, delete).
• Data Entry:
• Input and maintain accurate records of all incoming and outgoing documents, including claims, applications, and supporting documents.
• Enters data for envelopes, labels, form letters, and correspondence.
• Claim Processing:
• Consistently meet internal, external, and governmental timeliness standards in processing claims.
• Maintain compliance with established production and quality standards.
• Ensure accurate and proper denial processing in the system for claims deemed inappropriate for payment.
• General Duties:
• Work independently on assigned tasks and activities based on established policies and procedures.
• Perform basic arithmetic (add, subtract, multiply, divide).
• Detect and correct errors.
• Other related duties as assigned.

Requirements & Tech Stack

• Software Proficiency:
• MS Excel
• MS Word
• MS Outlook
• Typing Speed:
• 60 Words Per Minute (WPM) or 10,000 Keystrokes per Hour (KSPH).
• Office Equipment Familiarity:
• Photocopy machine
• Scanner
• Facsimile machine

Qualifications

• Excellent attention to detail, organization, and communication skills.
• High School diploma or equivalent.
• Knowledge of professional and institutional claim processing procedures, including COB (Coordination of Benefits)/TPL (Third Party Liability)/WC.
• Performs high volume data entry.
• Basic understanding of claims processes and workflows.
• Minimum of one year of practical experience or successful completion of an accredited vocational program in medical office and/or medical billing preferred.
• Ability to work independently and as part of a team in a fast-paced environment is essential.

Other Requirements

• Possession of a valid driver's license.
• Proof of state-required auto liability insurance.