Position Title: Claims Examiner III
Position Type: Full Time
Location: Huntington Beach, CA and Arcadia, CA
Reports To: Claims Manager
Clever Care Health Plan is a newly founded Medicare Advantage health plan serving Medicare beneficiaries in Southern California. Our employees are passionate in providing best services to our members and healthcare providers. Our three office locations are in Arcadia (Los Angeles County), Huntington Beach (Orange County) and New York City.
Under the direction of the Claims Manager, the Claims Examiner III reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Examiner III performs advanced administrative/operational/customer support duties that require independent initiative and judgment. This includes but is not limited to; Inpatient, COB high dollar, dialysis, oncology/chemo, home health agency, SNF, hospital exclusions and claim adjustments in an accurate and expedient manner. The position also includes auditing of professional claims for accuracy using, CCI edits, CMS LCDs, NCDs, and other Plan policies.
Typical Physical Demands.
Position requires a great amount of sitting and standing. Some lifting, stooping, bending, or reaching is required. May require lifting up to 15‐30 pounds. Requires manual dexterity sufficient to operate a computer, calculator and telephone. Requires normal range of hearing and vision. Requires the ability to type and file.
Typical Working Conditions.
Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. Work may be stressful at times. May occasionally work some irregular hours.