Sr. Medical Claims Examiner - (Orange, CA)

Sr. Medical Claims Examiner We are looking for an experienced Sr. Medical Claims Examiner with excellent analyzing skills. YOU will be accountable for following regulatory and internal guidelines in conjunction with policies and procedures. YOU will also adjudicate more complex claims, requiring additional research or issue solving. Position duties Responsible for accurate and timely adjudication of claims according to guidelines. Analyze, process, research, adjust and adjudicate claims with the use of accurate procedure/revenue and ICD-9 codes, under the correct provider and member benefits, i.e. co-payments, deductibles, etc. Claims processing based upon contractual and/or agreements, involving the use of established payment methodologies, Division of Financial Responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures. Responds to incoming calls from providers of service in a timely and courteous manner.