Claims Examiner III - Medicare Advantage

Take on a key role within a world-class, award-winning health system. Contribute to the delivery of award-winning patient care. Take your career in an exciting new direction. You can do all this and more at UCLA Health.

You will be responsible for accurate and timely data entry, and the review and adjudication of professional, ancillary, and institutional claims for services rendered in our inpatient, ambulatory and outpatient settings. This will cover all contracted lines of business in accordance with regulatory guidelines, contract provisions, and established policies and procedures. Working from batches, reports, in-basket pools, work queues, or other methods, you will be called on to meet established quality, productivity, service level, and turn-around requirements. This role requires the ability to research and resolve complex claim issues as well as train others on claims processes and workflows.

Salary Range:$29.42 - $42.14/Hourly

• High School Diploma, GED or equivalent experience
• Four or more years of medical claims payment experience in an HMO setting
• Expertise in industry standard claims adjudication policies, procedures, and processes
• In-depth knowledge of fee schedule and pricing methodologies for outpatient/inpatient institutional, ancillary, and professional claims
• Experience processing complex institutional claims
• Understanding of CPT, HCPCS, ICD-10, ASA, and revenue codes
• Knowledge of medical terminology
• Ability to accurately key 6,000-8,000 keystrokes or type 40-50 WPM
• Computer proficiency with Microsoft Office and data visualization tools
• Knowledge of claims adjudication systems (e.g., EPIC-Tapestry, EZ Cap, QNXT, IDX)
• Willingness to learn new technologies, practices, and procedures
• Strong problem identification, resolution, and analytical abilities
• Excellent communication, interpersonal, critical thinking and organizational skills