Sr. Claims Examiner

The Senior Claims Examiner supports management in the daily operations and timely processing of claims.  This position will be responsible for adjudicating complex claims which include high dollar claims.  Responsible for accurate manual pricing of claims.  Provides technical and/or process direction to a group of Claims staff to ensure claims are completed timely.  Provides phone support to our Providers and identify provider billing issues that impact claims processing. Works closely with Supervisor to identify any reporting or training needs and system problems that may be encountered. Maintain quality and production standards, teamwork and comply with company/ administrative policies and guidelines.  Responsible for other projects and duties as assigned. Senior Claims Examiners must be knowledgeable in CPT-4/HCPCS and ICD-9. Prior knowledge of medical terminology, Medicare/MediCal guidelines and regulations are also required. Requires a High School diploma or equivalent, some college preferred.  At least 2-3 years of claims processing experience; preferably in a Managed Care environment. CalOptima offers an excellent work environment that includes flexible scheduling plans, a highly competitive benefits package and an organizational mission that drives our employees to excel!