LHH
LHH is looking for Medical Claims Processor / Adjudicator who is responsible for accurately reviewing, analyzing, and processing managed healthcare claims, authorizations, and referrals in accordance with contractual agreements, regulatory guidelines, and organizational policies. This role requires a strong understanding of healthcare claims processing standards, medical billing regulations, and data integrity practices. The incumbent ensures accurate claim outcomes by verifying and updating data across multiple internal and external systems.
Essential Responsibilities Review, research, and adjudicate professional and hospital claims for all lines of business, ensuring timely and accurate payment or denial in compliance with policies and regulations.
Investigate claim holds and pends, tracking necessary information and documentation to facilitate resolution.
Conduct proactive and responsive outreach to providers, members, and internal stakeholders via phone, email, or other communication channels.
Collaborate with cross-functional teams to identify and resolve claim-related issues efficiently.
Provide feedback to supervisors and the training team regarding process improvements, training needs, and educational resources to enhance departmental productivity.
Assist with the preparation of documentation and materials for external audits as requested.
Identify and communicate emerging trends, issues, or discrepancies to leads and management.
Maintain up-to-date knowledge of applicable county, state, and federal healthcare regulations.
Perform additional related duties as assigned within the scope of the department.
Job Qualifications Minimum Qualifications Education : High School Diploma or General Education Development (GED) required.
Experience : Minimum of three (3) years of experience in claims adjudication required.
Additional Requirements : Demonstrated customer service experience.
Proficiency in basic PC operations and Microsoft Word.
Strong analytical and problem-solving skills with the ability to interpret and apply complex claims processing procedures.
Proven ability to work independently with minimal supervision.
Effective communication and collaboration skills in a team-oriented environment.
Ability to work effectively in a Labor Management Partnership setting.
Pay Details : $25.00 to $27.00 per hour
Search managed by : Abigail Revalee
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer / Veterans / Disabled To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www-uat.lhh.com/us/en/candidate-privacy
The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and / or security clearance requirements, including, as applicable :
The California Fair Chance Act
Los Angeles City Fair Chance Ordinance
Los Angeles County Fair Chance Ordinance for Employers
San Francisco Fair Chance Ordinance
Massachusetts Candidates Only : It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
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Essential Responsibilities Review, research, and adjudicate professional and hospital claims for all lines of business, ensuring timely and accurate payment or denial in compliance with policies and regulations.
Investigate claim holds and pends, tracking necessary information and documentation to facilitate resolution.
Conduct proactive and responsive outreach to providers, members, and internal stakeholders via phone, email, or other communication channels.
Collaborate with cross-functional teams to identify and resolve claim-related issues efficiently.
Provide feedback to supervisors and the training team regarding process improvements, training needs, and educational resources to enhance departmental productivity.
Assist with the preparation of documentation and materials for external audits as requested.
Identify and communicate emerging trends, issues, or discrepancies to leads and management.
Maintain up-to-date knowledge of applicable county, state, and federal healthcare regulations.
Perform additional related duties as assigned within the scope of the department.
Job Qualifications Minimum Qualifications Education : High School Diploma or General Education Development (GED) required.
Experience : Minimum of three (3) years of experience in claims adjudication required.
Additional Requirements : Demonstrated customer service experience.
Proficiency in basic PC operations and Microsoft Word.
Strong analytical and problem-solving skills with the ability to interpret and apply complex claims processing procedures.
Proven ability to work independently with minimal supervision.
Effective communication and collaboration skills in a team-oriented environment.
Ability to work effectively in a Labor Management Partnership setting.
Pay Details : $25.00 to $27.00 per hour
Search managed by : Abigail Revalee
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer / Veterans / Disabled To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www-uat.lhh.com/us/en/candidate-privacy
The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and / or security clearance requirements, including, as applicable :
The California Fair Chance Act
Los Angeles City Fair Chance Ordinance
Los Angeles County Fair Chance Ordinance for Employers
San Francisco Fair Chance Ordinance
Massachusetts Candidates Only : It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
#J-18808-Ljbffr