Provider Dispute Resolution Claims Examiner II
L.A. Care Health Plan
full-time
Posted on:
Location Type: Office
Location: Los Angeles • California • United States
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Salary
💰 $60,778 - $91,166 per year
About the role
- Process all types of claims with focus on L.A. Care direct services
- Meet production and quality standards set by PDR Claims Department Management
- Resolve provider claims payment disputes within the specific time frame as required by regulatory agencies
- Identify and report PDR trends to management for process improvement opportunities
- Work with internal departments to resolve issues preventing claims processing or enhance processing effectiveness
- Perform other duties as assigned
Requirements
- Associate's Degree
- At least 2 years of healthcare claims processing experience in a managed care environment
- Moderate knowledge of Microsoft Word and Excel
- Extensive knowledge of medical terminology, standard claims forms and physician billing coding
- Ability to read/interpret contracts and complete product and Coordination Of Benefits (COB) knowledge
- Experience processing PDR documents preferred
Benefits
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
healthcare claims processingmedical terminologyclaims formsphysician billing codingCoordination Of Benefits (COB)PDR documents
Soft Skills
problem-solvingcommunicationorganizational skillsattention to detail
Certifications
Associate's Degree