Medical Claims Examiner in Downtown SF

Great-West Healthcare, now part of CIGNA, is currently seeking Medical Claims Examiners to service a large multi-state client account. Our office is located in the heart of downtown San Francisco at the corner of 4th and Mission Street and is just one block from BART. The hours for this position are Monday through Friday, 8am to 5pm. The Medical Claims Examiner is responsible for processing specified medical claims in accordance with contract provisions using established policies and procedures. This requires a high level of quality and this role is accountable for meeting accuracy and productivity targets outlined in the current year's performance standards.

Primary Responsibilities Process medical claims in accordance with contract provisions, using established policies and procedures up to a designated payment authority level. Analyzing and researching the claims to determine correct payment, pend or denial determination is included in the process. Also included are verifying eligibility, assigning claim numbers, applying appropriate coding, etc. Attempt to obtain missing or incomplete information to pay a claim by contacting providers of service, suppliers, etc. Outreach may be over the phone or in writing. Refer claims when needed to appropriate positions within the Service Center according to claims referral policies. Review and understand all claims reference materials, and review and understand updates made to reference materials available in paper and/or electronic formats. Complete other various duties and responsibilities as deemed by the Supervisor.

 

Background and Qualifications High school diploma or equivalent. Minimum 3 years medical claims processing experience preferred. Sound knowledge of CPT, HCPCS, and ICD-9 codes. Excellent communication skills, both written and verbal, and excellent interpersonal skills. Excellent PC, keyboarding, and 10-key skills. Strong understanding of COB, including coordinating benefits with Medicare parts A and B. Strong research, analytical, and problem-solving skills. Attention to detail and dedication to quality work is crucial.

On April 1, 2008, Connecticut General Life Insurance Company (CG Life), a subsidiary of CIGNA Corporation and the primary operating company in the CIGNA HealthCare division, purchased the health care business of Great-West Life & Annuity Insurance Company, known as Great-West Healthcare. Between April 1, 2008, and approximately July 1, 2008, Great-West employees involved with Great-West's health care business will provide services to CIGNA HealthCare. If you become such a Great-West employee during this interim period, you will receive a separate offer of employment with CG Life. After the interim period, Great-West employees who accept CG Life offers of employment will become CG Life employees. For more information, please visit Great-West Life & Annuity at www.greatwest.com. We are equal opportunity employer dedicated to workforce diversity. We are committed to providing a drug-free workplace.

You'll find good people at Great-West.