Under the direction of the Claims Production Manager and Claims Supervisor, the Claims Processor II is responsible for receiving claims and processing the claims in an expedient manner. Major Functions (Duties and Responsibilities)
1. Responsible for non-delegated provider claims verification and adjudication. 2. Adjudicate all professional and outpatient facility claims including COB, denials, and reduction in service notifications 3. Interface with other IEHP Departments, when necessary, regarding claims issues. 4. Participate in Claims Department staff meetings, and other activities as needed 5. Responsible for meeting the performance measurement standards for productivity and accuracy for one specific type of claim form, professional (HCFA) or institutional (UB.) Supervisory Responsibilities Leading: Self Experience Qualifications
Two (2) years experience in examining and processing medical claims; professional or institutional. Preferred Experience
High school diploma or GED required. Preferred Education Professional Certification Professional Licenses Drivers License Required No Knowledge Requirement
ICD-9 and CPT coding and general practices of claims processing. Prefer knowledge of capitated managed care environment. Skills Requirement
Microcomputer skills, proficiency in Windows applications preferred. Excellent communication and interpersonal skills, strong organizational skills. Abilities Requirement
Professional demeanor. Commitment to Team Culture
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions
Data entry involving computer keyboard and screens, filing and copying of records and/or correspondence. Physical Requirements
Starting Salary: $38,563.20 - $45,302.40 Pay rate will commensurate with experience
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.
