Claims Processor II (MC)

Claims Processor II (MC)
In San Diego, California 92123

Job Description

Workway is a professional staffing firm, working with organizations across the country to place exceptional candidates. We are looking for a Claims Processor II (MC) responsible for the accurate review, input and adjudication of claims using reasonable payment policies and methodologies that are consistent with and recognized by Health Plans, nationally recognized medical organizations, federal regulatory bodies, and contractual obligations of the organization. 

Your specific duties will include:

  • Provide expertise and/or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims 
  • Authorize appropriate payment or refer claims for further investigation as appropriate 
  • Consistently meet established productivity schedule, adherence, and quality standards 

Specific qualifications for the position include

  • Minimum 4 years of experience in Managed Care (HMO and Medicaid) with demonstrated performance that consistently exceeds expectations
  • Proven knowledge of CPT, HCPCS, ICD-9/ICD-10, DRG’s, RBRVS codes and medical terminology for both electronic and paper claims
  • Proven knowledge of processing Provider Dispute Resolutions 

Let one of our recruiters assist you in finding and preparing for interviews with our clients. Whether you are interested in a direct hire, temp-to-hire, or temporary position, Workway can help you to put your best foot forward. Contact us today! 

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Abhijeet Pathak
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703-889-6814