claims processor

Mokan Sheet Metal Workers Welfare Fund

Provide high-level customer service while accurately processing Medical, Hospital, Dental, and ITS claims. Collaborate effectively with office staff in a team-oriented environment to ensure timely and accurate claim resolution. Maintain professionalism, attention to detail, and compliance with company policies while supporting both internal teams and customers.Job Type: Full-timePay: $23.00 - $25.00 per hourBenefits:<ul><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Vision insurance</li></ul>Physical Setting:<ul><li>Office</li></ul>Education:<ul><li>High school or equivalent (Preferred)</li></ul>Experience:<ul><li>Microsoft Office, Word, FACETS: 1 year (Required)</li><li>Customer Service/ FACETS: 1 year (Required)</li><li>Claims processing: 1 year (Required)</li></ul>Work Location: In person

Claims Processor

Blue Shield of California

<div>Your Role 
The Medi-Cal Operations team is responsible for ensuring claims are processed accurately and timely. The Claims Processor, Specialist will report to the Medi-Cal Operations Supervisor. In this role you will be responsible for interfacing with other departments and vendors involved in the Claims process and will also serve as the primary point of contact for priority claim cases. 
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.</div>
 <div>Your Work 
In this role, you will:
<ul><li>Handle most complex activities including backup for all areas of claims processing
</li><li>Actively participate in projects
</li><li>Handle escalated issues independently
</li><li>Mentor experienced team members
</li><li>Assist with training when needed
</li><li>Collaborate with peers, staff in other department's vendors, and Management to improve processes and department work quality.
</li><li>Must be able to work in a fast-paced environment with minimal supervision
</li><li>Read and interpret documents such as provider contracts procedure manuals, various reports, division of financial responsibility matrix</li></ul></div>
 <div>Your Knowledge and Experience 
<ul><li>Requires a high school diploma or GED
</li><li>Requires at least 7 years of experience
</li><li>Minimum of 3 years of experience in claims processing and/or auditing experience in a manage care setting required
</li><li>Experience examining multiple claim types in the Medi-Cal/Medicare environment preferred
</li><li>Knowledge of medical claims regulatory guidelines such as AB1455 and Medicare preferred
</li><li>Proficiency in Microsoft Office programs such as Excel, Word and Outlook required 
</li></ul>Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.</div>
 <div>ABOUT THE TEAM 
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
Our Values:
<ul><li>Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
</li><li>Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
</li><li>Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
</li></ul><div>Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
<ul><li>For most teams, this means coming into the office two days per week.
</li><li>Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
</li><li>For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
</li></ul>The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
</div>Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. 
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.</div>

Claims Processor, Specialist

Moda Health

<div>
 
 Let&rsquo;s do great things, together!
 
 
 
 
 About Moda
 
 
 
 Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we&rsquo;re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let&rsquo;s be better together.
 
 
 
 Position Summary
 
 
 
 Responsible for utilizing resources efficiently for the accurate and timely entry, review, and resolution of simple to moderately complex medical claims in accordance with policies, procedures, and guidelines as outlined by the company.
 
 This is a FT WFH role.
 
 
 
 
 Pay Range
 
 
 
 $17.34 - $19.41 hourly, DOE.
 
 
 <ul>
 <li>
 Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.
 
 
 </li>
 </ul>
 
 Please fill out an application on our company page, linked below, to be considered for this position.
 
 
 
 https://j.brt.mv/jb.do?reqGK=27774713&amp;refresh=true
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 Medical, Dental, Vision, Pharmacy, Life, &amp; Disability
 </li>
 <li>
 401K- Matching
 </li>
 <li>
 FSA
 </li>
 <li>
 Employee Assistance Program
 </li>
 <li>
 PTO and Company Paid Holidays
 
 
 </li>
 </ul>
 
 Required Skills, Experience &amp; Education
 
 
 
 <ul>
 <li>
 High School diploma or equivalent
 </li>
 <li>
 6-12 months data entry or medical office experience preferred
 </li>
 <li>
 10-key proficiency of 135 spm
 </li>
 <li>
 Type a minimum of 35 wpm
 </li>
 <li>
 Knowledge of medical terminology, CPT codes and ICD-9/10 codes preferred
 </li>
 <li>
 Demonstrates work habits that include punctuality, organization, and flexibility
 </li>
 <li>
 Ability to maintain balanced performance in areas of production and quality
 </li>
 <li>
 Analytical reasoning and flexibility
 </li>
 <li>
 Professional and effective written and verbal communication skills
 </li>
 <li>
 Experience with Facets platform a plus
 </li>
 <li>
 Identify all the duties and responsibilities
 
 
 </li>
 </ul>
 
 Primary Functions
 
 
 
 <ul>
 <li>
 Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
 </li>
 <li>
 Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.
 </li>
 <li>
 Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, out of pocket, etc.
 </li>
 <li>
 Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
 </li>
 <li>
 Adjudication of claims to achieve quality and production standards applicable to this position.
 </li>
 <li>
 Release claims by deadline to meet company, state regulations, contractual agreements, and group performance guarantee standards.
 </li>
 <li>
 Reviews Policies and Procedures (P&amp;P&rsquo;S) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
 </li>
 <li>
 Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
 </li>
 <li>
 Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs. Moda&rsquo;s standard workweek is a 37.5 hour work week.
 
 
 </li>
 </ul>
 
 Working Conditions &amp; Contact With Others
 
 
 
 <ul>
 <li>
 Office environment with extensive close PC and keyboard work with constant sitting. Must be able to navigate multiple screens. Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs. Moda&rsquo;s standard workweek is a 37.5 hour work week.
 </li>
 <li>
 Works internally with the customer service, membership accounting, and appeals departments. Works externally to support client needs.
 
 
 </li>
 </ul>
 
 Together, we can be more. We can be better.
 
 
 
 Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.
 
 
 For more information regarding accommodations, please direct your questions to Kristy Nehler &amp; Danielle Baker via our humanresources@modahealth.com email.
</div>

Medical Claims Processor I

Forest River, Inc.

Forest River, Inc., the Nation's largest manufacturer of Recreational Vehicles, Cargo Trailers, Transit Buses and Boats has an immediate opening.
 
Responsibilities
 
<ul>
<li>Process Warranty Claims submitted by our dealer base.</li>
<li>Answer questions regarding claims via phone/email.</li>
<li>Record retention and reporting.</li>
<li>Scanning documents.</li>
<li>Miscellaneous office duties.</li>
</ul>
Qualifications
 
<ul>
<li>Attention to detail and accuracy</li>
<li>Excellent computer skills, able to work in Microsoft Office programs efficiently</li>
<li>Must have good written and verbal communication skills</li>
<li>A desire to provide extraordinary customer service to the dealer/customer network</li>
<li>Able to work within a group and transition between responsibilities given</li>
<li>Willingness to learn many different components of a RV</li>
</ul>
Forest River offers a stable work environment that is fast paced. Our employees enjoy a highly competitive Wage and Benefit Package. We are looking for dedicated individuals with experience in the Industry as well as other Manufacturing Processes.

Warranty Representative/Claims Processor

Optum

<div>This position follows a hybrid schedule with employees will be required to work some days onsite and some days from home. Our office is located at OptumHealth Public Sector, 3131 Camino Del Rio North, Suite 700, San Diego, CA, 92108.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
This is a challenging role that takes an ability to thoroughly review, analyze and research complex healthcare claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. You'll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will support timely processing of the member's claim.
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm PST. It may be necessary, given the business need, to work occasional overtime.
We offer 90 days of online and onsite on the job training aligned to your schedule. 
Primary Responsibilities:<ul><li>
Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims</li><li>
Analyze and identify trends and provide reports as necessary</li><li>
Consistently meet established productivity, schedule adherence and quality standards</li><li>
Other duties as assigned</li></ul> 
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
High School Diploma / GED OR equivalent work experience</li><li>
Must be 18 years of age OR older</li><li>
1+ years of experience in a related environment (i.e., office, administrative, clerical, customer service, etc.), using phones and computers as the primary job tools</li><li>
Experience using computers and Windows based applications, which includes the ability to learn new and complex computer system applications</li><li>
1+ years of experience using Microsoft Office applications</li><li>
1+ years of experience with processing medical, dental, prescription, OR mental health claims</li><li>
Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm PST. It may be necessary, given the business need, to work occasional overtime.</li></ul> 
Telecommuting Requirements:<ul><li>
Reside within commutable distance to the office at OptumHealth Public Sector, 3131 Camino Del Rio North, Suite 700, San Diego, CA, 92108</li><li>
Ability to keep all company sensitive documents secure (if applicable)</li><li>
Required to have a dedicated work area established that is separated from other living areas and provides information privacy.</li><li>
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.</li></ul> 
Soft Skills:<ul><li>
Ability to work independently and prioritize tasks</li><li>
Display strong work ethic, independence, and dependability</li><li>
Exhibit excellent time management, organizational, and prioritization skills</li><li>
Demonstrate the ability to multitask</li><li>
Possess effective interpersonal, influence, collaboration, and listening skills</li><li>
Drive for results individually and in a team setting</li></ul> 
<ul><li>All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $17.98 - $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. 
#RPO</div>

Claims Representative

Great Expressions Dental Centers

What you’ll do…
 The Claims Resolution Representatives primary role is to resolve high volumes of aging insurance claims with payers and providers by calling insurance companies or by utilizing their websites when available. This person should be detail oriented and can communicate effectively with insurance companies. While it is important to work well with their team it is equally important that they are self-motivated.
 
This position is located at our corporate office in Southfield, MI and has a hybrid schedule of Monday, Tuesday, Thursday in office and Wednesday/Friday remote.
 
What you’ll bring to the team…
 <ul>
<li>Ability and self-confidence to communicate effectively, and tactfully, to both large insurance company representatives and individual clients</li>
<li>Resolving high volumes of aging insurance claims</li>
<li>Other tasks as requested by direct Manager</li>
</ul>
What we require you have…
 <ul>
<li>High school diploma or GED</li>
<li>Bachelor’s degree preferred</li>
<li>Experience in insurance claims is a plus</li>
<li>Analytical and problem solving skills with a passion for detail & accuracy</li>
<li>Reliability and flexibility with time committed to the position</li>
<li>Excellent organizational and time management skills</li>
<li>3+ years Dental Front Desk or Medical or Dental Claims Processing experience</li>
<li>Prior experience with insurance or accounts receivable (denied claims)</li>
<li>High volume, fast-paced office experience a plus</li>
<li>Proficiency in Microsoft Outlook and Excel</li>
</ul>
About GEDC…
 Since 1982, Great Expressions has been at the forefront of dental innovation, setting the standard for exceptional care and unforgettable patient experiences. Now, we're entering a new era of transformation, and we want you to be a part of it. Our recently appointed leadership team brings over a century of collective dental expertise and is backed by dynamic investment support to pave the way for groundbreaking changes. We're channeling our resources and energy into revolutionizing our technology platform, expanding service offerings, and creating a personalized patient experience that goes beyond the expected. At Great Expressions, we're not just transforming dentistry; we're investing in the growth and development of our team. Join us and be a part of a career that blends innovation and professionalism, where your contribution shapes the future of dental excellence.
 
#IND7
 
GEDC is committed to diversity and inclusion and is proud to be an equal opportunity employer. All qualified applicants are welcomed and encouraged to apply.

Claims Resolution Representative

Medlogix

<div><div><div><div><div><div>Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our medlogix&reg; technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients&rsquo; needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers&rsquo; compensation insurance carriers; third party administrators (TPAs); and government entities we serve.</div><div></div><div><div><div> 
Position: Bill Repricer Level II</div><div>
Location: Remote</div><div>
FMLA: Non-Exempt, Full-Time</div><div>
Schedule: M-F 8am-4:30pm</div><div><div><div><div><div><div> 
General Description: 
 
Process Auto Medical and Workers Compensation Bills through various work queues based on jurisdictional and process requirements of Medlogix clients. 
 
Responsibilities:<ul><li>
Process and reprice auto medical claims through different system queues in &ldquo;first in first out&rdquo; order and making sure to keep up with client and regulatory SLAs.<ul><li>
Resolve bill exceptions, verify bill data (bill images against captured data) and resolve discrepancies, follow and apply claims adjuster instructions, review for medical records and flag errors to rejection queue.</li></ul></li><li>
Maintain communication when needed, between yourself and your supervisor</li><li>
Reach a daily average quota with the amount of claims/jobs you process</li><li>
Other job duties as assigned 
</li></ul>
Qualifications and Experience: 
 
Required:<ul><li>
Excellent written and verbal communication skills</li><li>
Must be process and task oriented</li><li>
Computer savvy and previous experience using Microsoft Office Products</li><li>
1+ years medical coding experience &ndash; CPT, ICD</li><li>
1+ years experience in Medical Bill Repricing</li></ul> 
Preferred: 
<ul><li>
Previous experience in Auto Claim Management</li><li>
Previous experience working in a fast-paced production environment</li></ul><div>
EEOC STATEMENT:</div><div></div><div> 
Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.</div></div></div></div></div></div></div></div></div></div></div></div></div></div><div></div>

Bill Review Repricer - Level II (Remote)

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