Under close supervision, the Claims Examiner I will perform accurate review, entry and processing of all claims received for payment by HPSM.

Position overview

Essential Functions:

Research rejected claims as necessary and re-adjudicated them when resolved.
Claims entry of all standard claim forms.
Correspond as required to resolve rejected claims.
Review reports, verifying accurate data and making corrections as appropriate.
Review fewer complex edits to determine the appropriate handling for each including paying, denying, or pending for Analyst II or III to review.
Use Policies & Procedures, Claims Manual and other sources to complete the required number of weekly reviews required for this position.
Assist in creation and development of memos, processes and tools when needed.
Monitor own performance via production and auditing tools and reports.
Attend team, company, and one-on-one meetings and other functions.
Communicate issues with Manager and Claims Auditor; make recommendations on claims issues.

Secondary Functions:

Attend team, company, and one-on-one meetings and other functions.
Communicate issues with Manager and Claims Auditor; make recommendations on claims issues.
Perform other duties as assigned.

Requirements
These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.

Education and experience are equivalent to:

High School diploma, GED or equivalent required.
Two (2) years’ general office experience. Claims processing experience preferred.

Knowledge of:

Medical billing and terminology.
Medi-Cal and Medicare programs.
Procedure and diagnostic coding.
Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint.

Ability to:

Work cooperatively with others.
Work as part of a team and support team decisions.
Communicate effectively, both verbally and in writing.
Adapt to changes in requirements/priorities for daily and specialized tasks.
Perform alpha-numeric data entry proficiently.
Perform with attention to detail.
Organize and prioritize daily work, complete multiple tasks within established time frames.
Communicate effectively, verbally and in writing.
Maintain accurate records.
Use clear notes or remarks to document relevant information.
Exercise good judgment within scope of authority.
Handle confidential issues with tact and diplomacy.
NCCI Edits experience a plus.

Salary and benefits
The starting salary range is $21.31 - $26.95 per hour, depending on the candidate’s work experience.

Excellent benefits package includes:

HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
Fully paid life, AD&D and LTD insurance
Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
Tuition reimbursement plan
Employee wellness program

It is HPSM's policy to provide equal employment opportunities for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.

Health Plan of San Mateo

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Claims Examiner I