APR Consulting, Inc. has been engaged to identify a Claims Processor

Location: San Diego, CA 92122 (Remote)
Position: Claims Processor
Pay Rate: $32.98 per/hr.
Duration: 13 Weeks
Expected Schedule: Monday - Friday 6:00 AM - 2:30 PM

“Teleflex” work arrangements available following completion of training, which means most of the time the employee can work remotely, but needs to physically be in the region to be able to come on site if/when a business needs arise.

Job Description:

• Process complex claims for all lines of business. Process and understand COB adjudication.
• Understand and investigate TPL claims.
• Finalize fatal electronic interface claims. Initial and ongoing training of Claims Department staff.
• Assist in system upgrades and implementation of new or revised software related to claims adjudication.
• Special projects as assigned.
• Extensive knowledge of Epic AP Claims, CPT, ICD, ASA and HCPCS coding.
• Extensive knowledge of AWP calculation. Must have 95% audit results.
• Must have 5+ years claims experience.
• Must have production average of 15 claims per hour.
• Job standards to be performed at the EXPERT level.

Required Qualifications:

• Minimum 5 years relevant experience.
• Expert knowledge of current HMO claim processing protocols and regulatory guidelines.
• Extensive knowledge of CPT, ICD, ASA and HCPCS coding as pertains to claim adjudication.
• Proficiency with MS Word, MS Excel, MS Outlook, and Internet Explorer.
• High school diploma or equivalent.

Preferred Requirements:

• Experience with Epic AP Claims claim processing system.
• Healthcare environment experience.
• 4-year college degree

Our client is one of the largest non-profit health plans founded in 1945 which offers comprehensive, affordable health coverage plans for individual & family, Medicare, employers, and large group.

This particular client is requiring that all new hires show proof of vaccination. However, accommodations may be made for those with disabilities or religious reasons who cannot obtain a vaccine.

Since 1980 APR Consulting, Inc. has provided professional recruiting and contingent workforce solutions to a diverse mix of clients, industries, and skill sets nationwide.

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

Don't miss out on this amazing opportunity! If you feel your experience is a match for this position please apply today and join our team. We look forward to working with you!