We are looking for a competent Medical Claims Representative to join our team in Los Angeles, California. The Medical Claims Representative will be primarily responsible for monitoring, investigating and analyzing relevant agreements, as well as handling claims payments and maintaining effective communication with various stakeholders.
Responsibilities:
• Handle the filing and pursuit of claims payments meticulously and efficiently.
• Answering inquiries regarding EOBs as well as any other issues pertaining to medical claims
• Monitor and analyze healthcare industry trends and developments, and understand their implications on claims.
• Investigate potential violations of collective bargaining agreements and take necessary action.
• Maintain timely and effective communication with members, agents, attorneys, and company representatives.
• Manage workload independently, ensuring all tasks are completed accurately and on time.
• Work closely with the legal department to provide information/analysis of associated claims.
• Research and analyze various agreements, including member contracts, assumption agreements and distribution agreements.
• Handle appeals, benefit functions, billing functions, claim administration, and collection processes effectively.
• Maintain a strong focus on customer service, ensuring all queries and issues are resolved promptly and professionally.
• Medical Claims
• Familiarity with Medical Insurance or Medical Billing
• Experience in managing Appeals processes
• Understanding of Benefit Functions within a healthcare setting
• Proficiency in Billing Functions specific to medical claims
• Experience in Claim Administration procedures and processes
• Familiarity with Collection Processes in a healthcare environment