Job Description


Monterey, CA

Full Time

Work Hours: M - F 8AM - 5PM

8/8/2019

Claims Analyst - Aspire Health PLan

job summary:

The Claims Analyst is responsible for processing health insurance claims in accordance with the terms of individual benefit contracts.

Responsibilities:

  • Process medical, dental, and vision claims
  • Code medical procedures, diagnoses and supplies
  • Coordinate benefits with other group health plans
  • Interpret plan documents and apply plan benefits based on that interpretation
  • Verify eligibility and authorization
  • Refer appropriate claims, pre-certifications and appeals to management and/or medical review
  • Request necessary documentation from providers and/or insureds
  • Assist in the investigation of possible fraudulent claims
  • Investigate injury cases for third party liability or workers’ compensation
  • Perform other duties and functions as assigned

Requirements:

  • High school diploma or equivalent
  • Experience in the processing of health insurance claims or equivalent practical experience in a medical office
  • Knowledge of medical terminology, insurance billing and coding
  • Ability to operate software programs and computer equipment required to fulfill position responsibilities
  • Ability to problem solve
  • Able to work in a team environment
  • Able to conduct oneself in a professional manner

equal opportunity employer

Application Instructions

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