Claims Processor Rep - Cerritos, CA

Direct Staffing Inc; Cerritos (CA); On-site; USD 40,000 - 55,000; Full time

Job summary

A leading staffing agency is seeking an experienced Site Logistics Operator to manage claims processing in Cerritos, CA. The ideal candidate has 2-5 years of experience in claims processing, particularly with Medicare and Medicaid claims. Responsibilities include analyzing and processing claims, ensuring accuracy, and resolving issues while meeting production standards. Strong attention to detail and good communication skills are essential for success in this role.

Qualifications

• Requires 2-5 years of claims processing experience.
• Must have claims adjudication experience.
• Experience with Medicaid, Medicare, and/or Medi-Cal claims preferred.

Responsibilities

• Process and analyze claims with a focus on accuracy and quality.
• Research and resolve claims issues independently.
• Meet production standards and targets.

Skills

Detail oriented

Good PC skills including MS Word and MS Excel

Good oral and written communication skills

Good time management skills

Education

High School diploma or equivalent

Job description

Kelly Services is looking to hire several Site Logistics Operators/Material Handlers in Knoxville, TN for an industry leading chemical company. For this opportunity, you could be placed as a Chemical Finished Product Operator or a Polymers Packaging/Warehousing/Shipping Operator on a long-term, indefinite assignment. You will be working with chemicals and should be comfortable doing such - either with previous experience or the willingness to learn.

Job Description

• Able to handle more complex claims.
• Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits, and healthcare terminology.
• Good working knowledge of claims and products, including the grievance and/or re-consideration process.
• Excellent knowledge of the various operations of the organization, products and services.
• Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement.
• Researches and analyzes claims issues.
• Responds to inquiries, may involve customer/client contact.
• Must meet production and quality standards.
• Claims processing accuracy of 99% and above and the ability to process 120 or more claims per day.
• Proficient in claims adjudication and knowledge of Medicare.

Qualifications

EDUCATION/EXPERIENCE:

• Requires a HS diploma or equivalent; 2‑5 years of claims processing experience ; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.); or any combination of education and experience, which would provide an equivalent background.
• Claims adjudication experience a must.
• Experience with Medicaid, Medicare and/or Medi‑Cal claims highly preferred.
• Knowledge of contracts, CPT, HCPCs, ICD‑9/10 and Medicare billing guidelines.
• High School diploma or any combination of education and experience, which would provide an equivalent background.

SKILLS:

• Ability to effectively apply knowledge gained in training.
• Detail oriented. Good PC skills including MS Word and MS Excel.
• Good oral and written communication skills.
• Ability to identify problems and logically research with minimum assistance to locate answer through appropriate reference materials.
• Good time management skills.
• Maintains positive and cooperative working relationships with co‑workers and other associates.

Additional Information

All your information will be kept confidential according to EEO guidelines.