Claims Examiner I

As a ministry of the Sisters of St. Joseph of Orange, here at St. Joseph Heritage  Healthcare, we strive to create environments that promote wholeness for the communities and people we serve.  We currently have an outstanding opportunity for you in Network Support Services as a Claims Examiner I 

Working under the direction of the Claims Director, this position is responsible for consistently and accurately adjudicating all contracted professional capitated claims for both Commercial and Senior plans within the timeliness and accuracy standards set forth by CMS, Department of Managed Care, AB1455 and the Claims Department policies and procedures.

Some of the Essential Job Functions are:Reviews and processes all contracted capitated claims and fee-for-service PCP administration fee for service clams paid and or denied while achieving and maintaining a 95% accuracy rate, a 95% timeliness standard and maintaining a 95% production requirement.

Experience and Education required:High School Diploma or Equivalent. One year prior experience in an IPA, MEdical Group or Health Plan setting. Familiarity with computerized claims processing/transaction system is a PLUS!

 

Our benefits for full time personnel include Medical, Dental, Vision, Life Insurances, PTO, Paid Holidays, 401(a) and 401(k) plans, Credit Union and much more!