Claims Examiner 1 - (Bakersfield, CA)

Job summary: We have an immediate need for multiple Claims Examiner Under management direction, responsible for reviewing and processing all types of medical and facility claims from contracting and non-contracting providers and from subscribers and enrollees for payment in an accurate and timely manner. Responsible for applying correct contract benefits, policies and procedures. Critical functions Resolve system suspended claims for: PCPs Labs Radiology Less complicated specialists Physical Therapy Deny inappropriate claims following policy guidelines. Prepare claims that must be routed to other departments for further review. Review difficult claims with guidance