Job Summary

33857 - Claims Representative II (Hlth & Dntl)

  • Location:
    Cerritos, CA
  • Job reference:
    US_EN_6_983172_713471
  • Category:
    Administrative / Clerical
  • Contract Type:
    Contract/Temporary

Responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures. Works without significant guidance w/ basic understanding of multiple products (HMO, PPO, COB, etc.). Must be able to successfully perform all the duties of the Claims Rep I. Primary duties may include, but are not limited to: Able to handle more complex claims. Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, gov't regs, coordination of benefits, & healthcare terminology. Good working knowledge of claims and products, including the grievance and/or re-consideration process. Excellent knowledge of the various operations of the organization, products, and services. Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement. Researches and analyzes claims issues. Looking for someone who has done claims adjudication as well



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