Claims Adjuster, Health & Pensions (Entertainment)

Burbank, CA 91505

Employment Type: Direct Hire Category: Professional Services Job Number: WH-SC-MedCla01 Pay Rate: $55-60k DOE

We are interviewing Claims Adjustor to assist with correctly applying cash and insurance payments at our client’s group health benefits provider for members of the entertainment industry.

Our client provides vision, dental, psychiatric, medical and other healthcare benefits to members (and their dependents) of creative industries, including motion picture, television and commercial production. They are known for far reaching efforts that contribute to the general health and well-being of all its members. Our client also has a long history of charitable involvement in the community and encourages employees to volunteer time to their own special interests or those supported by the organization (such as The Actors Fund and Alzheimer’s research).

The Claims Adjuster will review, investigate, resolve and process hospital and professional claims and provides customer service support.

Ideal candidates bring at least 4 years’ experience in medical claims adjusting, has a BA degree and a solid medical industry foundation. This role uses analytical, investigative and negotiation skills to resolve claims with accuracy and urgency.

About the Position:

  • Respond to claim inquires
  • Reviews and adjudicates paper based claims
  • Research and process responses
  • Verify COB information
  • Perform adjustments on claims
  • Contact attorneys and/or other requestors regarding administrative fees, authorization requirements and confidential forms
  • Request claims records for outside vendors and internal projects
  • Write response letters and requests for claims information to attorneys and others
  • Handle all phone inquiries from external parties
  • Assist in determination of reimbursement amounts
  • Maintain, track and report recoveries and outstanding balances
  • Assist with company efforts to maximize recovery and minimize recovery expense
  • Obtain facts needed to resolve insurance claims
  • Identify legal ramifications of facts obtained
  • Analyze insurance policies to assess coverage
  • Determine the value of financial loss
  • Follow HIPAA rules in all tasks
  • Assist with data retrieval and audits
  • Special assignments

This is not a comprehensive list of tasks associated with this position.

About The Candidate:

  • AA+ degree (PLUS)
  • 4+ years’ experience in claims processing (MUST)
  • 3+ years’ experience in healthcare environment (MUST)
  • 3+ years’ experience in medical billing (MUST)
  • 2+ years’ experience working with HMO/PPO, Managed Care, Medicare/Medi-Cal (MUST)
  • 1+ years’ experience with CPT, HCPCS and ICD10 Codes, NAIC COB rules (MUST)
  • 1+ years’ experience using 10key by touch (PLUS)
  • 1+ years’ experience using Vitech System (PLUS)
  • Accurate data entry and typing skills of 45 WPM+ (MUST)
  • Advanced computer/software skills: Outlook, Word, Excel, Powerpoint (MUST)
  • Desired Personality Traits and Advanced Skills: accurate data entry, able to communicate clearly and concisely, ability to recognize trends, analyze and prioritize issues, attention to detail, organized, conflict/problem resolution, unwavering integrity, confidentiality, discretion

Equal Opportunity Employer considering qualified candidates in accordance with state and federal laws, including those with criminal histories, in a manner consistent with the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance.

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