Senior Claims Examiner

Western Growers; Fresno (CA); Remote; USD 45,000 - 64,000; Full time

Job summary

An established industry player in the agricultural sector is seeking a Senior Claims Examiner to join their remote team. This role involves processing complex health care claims with a focus on accuracy and compliance. You will review and analyze claims, mentor team members, and lead process improvement initiatives. The company is dedicated to providing robust health plans for a diverse workforce, making this an excellent opportunity for those looking to make a difference in healthcare. Join a team that values quality service and continuous improvement while enjoying the flexibility of remote work.

Qualifications

• 5-7 years of experience in health claims examination or similar.
• Ability to interpret Plan Documents and utilize medical terminology.

Responsibilities

• Adjudicate various types of claims and ensure accuracy.
• Assist in process improvements and compliance activities.

Skills

Health claims examination

Claims processing

Medical terminology and coding

Data entry

Microsoft Office proficiency

Time management

Problem-solving

Understanding of ERISA guidelines

Education

High school diploma or equivalent

Job description

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Description

Part of the Western Growers Family of Companies, Western Growers Assurance Trust (WGAT) was founded in 1957 to provide a solution to a need in the agricultural community — employer-sponsored health benefit plans. WGAT is now the largest provider of health benefits for the agriculture industry. The sponsoring organization of WGAT is Western Growers Association, created in 1926. WGAT’s headquarters is in Irvine, California.

WGAT’s mission is to deliver value to agriculture-based employer groups by offering robust health plans for a diverse workforce. Working at WGAT means joining a team committed to offering quality health benefits and excellent customer service. If you want to make a difference in healthcare, apply to WGAT today!

Compensation: $45,091 - $63,617 with benefits including profit-sharing.

This is a remote position, open to candidates anywhere in the U.S.

Job Description Summary

The Senior Claims Examiner processes complex health care claims, requiring high accuracy. Responsibilities include reviewing, analyzing, and researching claims, verifying pricing and authorizations, and assisting with escalated issues. The role involves working on special projects, mentoring team members, and leading training and process improvement activities.

Qualifications

• High school diploma or equivalent; 5-7 years of experience in health claims examination or similar.
• Extensive claims processing experience, understanding of various claims types and insurance plans.
• Ability to interpret Plan Documents and utilize medical terminology and coding.
• Excellent communication skills and proficiency in data entry and Microsoft Office.
• Strong time management, multitasking, and problem-solving skills.
• Knowledge of ERISA claims processing guidelines.

Duties and Responsibilities

• Adjudicate various types of claims, research queries, analyze medical information, and ensure accuracy.
• Review complex claims, collaborate with providers, and ensure timely processing.
• Assist in process improvements, compliance, and training activities.
• Maintain HIPAA compliance and support legal and customer service functions.

Additional Information

• Engage in continuous process improvement and act as a subject matter expert.
• Contribute to team goals and uphold company values.

Work Environment

The role involves communication, movement within the office, and handling tools and controls. Reasonable accommodations are available for disabilities.

Job Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Finance and Sales
• Industries: Non-profit Organizations