CLAIMS PROCESSOR, Grade 6 Job in Oakland, California US
CLAIMS PROCESSOR, Grade 6
Essential Functions: - Review, evaluate and screen Health Plan claims for completeness, accuracy and conformity to established policies and procedures. - Make payment or denial decisions in accordance with policy and procedures of Health plan Claims Department. - Authorize payments of claims in an amount based on authorization level guidelines. - Review and evaluate complex claims involving Medicare, contracts, other insurance, workers compensation, foreign claims and coordination of benefits. Qualifications: Qualifications: Basis Qualifications: - High School, GED - 2 - 3 years of Claims experience in an automated claims processing environment. - Excellent analytical skills. - Must have the ability to make decisions in accordance with established policies and procedures and claims practices and work independently as required. - Must possess knowledge of Medicare guidelines, data entry procedure, ICD-9, CPT 4 coding applications, medical terminology and claims practice. - Thorough knowledge of claims processing terminology, equipment, procedures and practices. - Must be able to establish and maintain effective working relationships with other employees, supervisors and the public. - Must have considerable skills in analysis, interpretations, and application of procedures, practices and methods used in claims problem-solving and resolution. - Must be able to meet the public and discuss claims issues and problems / complaints tactfully courteously and effectively. - Must be able to work in a Labor / Management Partnership environment. Skills Testing: Data Entry (10-key), Data Entry (Alpha- Numeric) 7000 keystrokes