Johnson Service Group (JSG) is seeking a Claims Examiner II. This is a remote opportunity for a health plan organization. Work Schedule: Monday- Friday 8am-5pm Pay rate range: $24-$30 per hour DOE General Description Under general supervision, the Claims Examiner reviews and resolves a caseload of claims with varying degrees of complexity within established timeframes and using appropriate program policies and procedures. Reviews may include medical, dental, inpatient and/or DME claims that require intervention for pricing, documentation requirements, appropriate coding and benefit determinations. Duties & Responsibilities Essential Functions: • Independently review claims edits with varying degrees of complexity to determine the appropriate handling for each including paying, denying, pending, adjusting, referring or forwarding claims to be sent back to the provider • Responsible for accurate and timely adjudication and review of claims according to company guidelines. • Use policies & procedures, claims manual and other sources to complete the required number of weekly reviews deemed appropriate for this position. • Provide peer-to-peer training as needed. • Provide accurate and timely information regarding daily production, claim issues, training and other reasons for time off production. • Monitor own performance via production and auditing tools and reports. • Communicate issues with the Manager and Claims Auditor; make recommendations on claims issues and opportunities for improvement. Secondary Functions: • Attend team, company, and one-on-one meetings and other functions. • Communicate issues with Manager and Claims Auditor; make recommendations on claims issues. • Perform other duties as assigned. Qualifications Education and experience are equivalent to: • High School diploma, GED or equivalent required. • Two (2) years of experience processing medical and/ or dental claims. Knowledge of: • Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint. • Medical billing and terminology. • Medi-Cal medical and/or dental program, and Medicare programs. • Procedure and diagnosis coding. JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law. #D800
