VCN Healthcare Jobs

Claims Examiner | Healthcare account - VOICE

Compensation & Benefits:

• HMO up to 4 dependents

• Group Life Insurance

• Retirement Benefit

• Investment Opportunities

• Corporate Loan Assistance

• Tenure-based Benefits

• Profit Sharing

Responsibilities:

• Receiving calls about health care insurance coming from network providers

• Review of claims based on provider and health plan contractual agreements, claims processing guideline, reviewing duplicate claims and coordinating benefits (COB) with other health insurance.

• Review of manual processing to ensure accuracy and timeliness of claims processing.

• Accountable to support company?s goals and follow all set processes.

• Using DOFR-Division of Financial Responsibility ? Identify claims that are not our clients financial risk.

• Verify patient?s accounts for eligibility and benefits.

• Read, interpret and summarize provider contracts.

• Validate paper claims data against system data for accurate data capture.

• Adjudicate claims in accordance with department policies and procedures and other business rules.

Qualifications:

• Bachelor's Degree in Healthcare or any related field

• Must have experience handling HMO Claims

• Excellent verbal and written communication skills.

• Be able to receive direction and training on extensive claim adjudication.

• Knowledgeable of Medi-Cal and Medicare are a plus

• Knowledgeable of EZ Cap claims platform and claims adjudication process are preferred but not a requirement

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