Claims Service Specialist Los Angeles-Hybrid (on site and remote) $65 to $70k

  • Los Angeles, CA
  • Salary: Range $65000 to $70000 annually DOE

Claims Service Specialist

 

POSITION SUMMARY:

The Claims Service Specialist provides medical, dental and vision claims adjudication (processing) for our valued client, the Los Angeles Firemen’s Relief Association. The Specialist also provides individual support plan to members who need personal attention to resolve benefit questions and to ensure the highest level of attention to their claims.

 

  • Respond to inquiries from callers, walk-ins or correspondence regarding health plans, policies, and procedures.
  • Utilize reference material including plan documents and fee schedules to obtain accurate information.
  • Prepare correspondence and documents to respond to inquiries or to adjust records.
  • Prepare routine reports and document all phone inquiries in patient notes.
  • Research claims in order to apply the proper limitations and provisions of each plan.
  • Read, interpret, understand and apply contract benefits, limitations and provisions.
  • Understand and apply insurance laws and regulations.

 

JOB DUTIES:

  • Work under the guidance and direction of the Account Executive and Claims Supervisor
  • Research disputed benefit coverage issues as identified in Health Plan Benefit Documentation.
  • Respond to inquiries from callers, walk-ins or correspondence regarding health plans, policies, and procedures.
  • Utilize reference material and fee schedules to obtain accurate information.
  • Contacting sources within or outside the organization to obtain information.
  • Identify and determining action to be taken in order to resolve a variety of problems.
  • Prepare or initiate a variety of correspondence and documents to respond to inquiries or to adjust records.
  • Prepare routine reports and document all phone inquiries in patient notes.
  • Research claims in order to apply the proper limitations and provisions of each plan.
  • Read, interpret, understand and apply contract benefits, limitations and provisions.
  • Understand and apply insurance laws and regulations.
  • Refer to various manuals, fee schedules and reference materials to obtain accurate information.

 

 

Requirements 

  • High School Diploma or GED.
  • Prior experience in a healthcare related field a plus.
  • 2 plus years’ experience with claims/call center health insurance environment.
  • Experience in self-funded plan administrations a plus.

 

 

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