Description A Healthcare IPA in Long Beach is in the need of a Medical Claims Examiner III. This role of Medical Claims Examiner III will be an essential position within the organization. The Medical Claims Examiner III is responsible for collaborating with the team to meet productivity goals as well as ensure quality. The Medical Claims Examiner should possess claims knowledge, prioritizing skills, and the ability to multi-task. EZ CAP software is a must. Audit claims processing quality, develops, maintains and runs standard reports Assist the Claims Supervisor/Director in reviewing the quality auditing tracking/reporting (financial and procedural) Coordinating with various departments to resolve disputes or issues Review and process hospital claims and complicated claims to assist claims examiners I, and II Claims processing to ensure quality (in/outpatient hospital claims, Medi-cal, Commercial, and Medi-care claims) Review auto adjudication of claims Review carve-outs in the Division of Financial Responsibility (DOFR) Review and process reports and work with management and claims unit Assist the Claims Manager in reviewing the quality auditing tracking/reporting Assist with training/supporting the claims team Recommend and assist in the development of process improvements Coordinating with various departments to resolve disputes or issues Able to process a claim and assist the team by answering questions and providing supportRequirements Medical Claims, EZCAPRobert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .
