Claims Specialist

• Responsible for non-delegated provider claims verification and adjudication
• Adjudicate all professional and outpatient claims including COB, denials, and reduction in service notifications
• Meet Regulatory Compliance Regulations on turnaround times and claim payments
• Read and interpret Medi-Cal/Medicare Fee Schedules
• Must be able to make a sound determination if claim is eligible for payment or denial
• Interface with other IEHP Departments, when necessary, regarding claims issues
• Participate in Claims Department staff meetings, and other activities as needed
• Responsible for meeting the performance measurement standards for productivity and accuracy
• Any other duties as required to ensure the Health Plan operations are successful

Claims Processor II

Senior Claims Examiner, Casualty

Claims Processor

Claims Representative