Position Title: Claims Processor

Position Number: 354481

Location: La Palma, CA 90623

Position Type: Temporary

Required Skill Set:

Claims, Insurance, MS Office 2003

Position Description:

Only U.S. Citizens and those authorized to work in the U.S. can be considered as W2 candidates. JOB TITLE: Claims Processor JOB ID: 62319 DURATION: 3 months HOURS: 7:30-4 LOCATION: La Palma, CA 90623 SPRINT: Do you have 4+ years claims adjudicating experience, preferably in a managed care setting? Explain Have you had to adhere to production quotas? Explain Specific Duties: • To batch and prioritize claims processing utilizing the Company’s in-house claims processing system.* • To verify patient’s accounts for eligibility and benefits.* • To accurately process complex claims that have been accepted for payment.* • To request and follow-up on additional information as needed for incomplete claims.* • To complete all steps above within designated timeframes (production quotas) and notify management if claims cannot be processed within the designated time frame.* • To assemble denial letter background information and generate denial letters.* • To read, interpret and summarize medical contracts/division of responsibility. • To identify claims that is not our financial risk and forward to appropriate entity for payment. • To review claims that is pending and follows through for payment in a timely manner. • To treat peers, superiors, subordinates clients and vendors with fairness, courtesy and professionalism and contribute to the overall positive work environment of the department. • To complete other production projects as assigned. • To have the ability to process both IPA and Hospital claims. Must have qualifications/experience: 1.• Requires the ability to speak, read, write and understand English and other general educational skills as is generally obtained by completing high school or a GED. 2• Requires 4+ years claims adjudicating experience preferably in a managed care setting.

JOB REQUIREMENTS:

SPECIFIC DUTIES: • To batch and prioritize claims processing utilizing the Company’s in-house claims processing system.* • To verify patient’s accounts for eligibility and benefits.* • To accurately process complex claims that have been accepted for payment.* • To request and follow-up on additional information as needed for incomplete claims.* • To complete all steps above within designated timeframes (production quotas) and notify management if claims cannot be processed within the designated time frame.* • To assemble denial letter background information and generate denial letters.* • To read, interpret and summarize medical contracts/division of responsibility. • To identify claims that is not our financial risk and forward to appropriate entity for payment. • To review claims that is pending and follows through for payment in a timely manner. • To treat peers, superiors, subordinates clients and vendors with fairness, courtesy and professionalism and contribute to the overall positive work environment of the department. • To complete other production projects as assigned. • To have the ability to process both IPA and Hospital claims.

ROSE INTERNATIONAL IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, AGE, SEX, SEXUAL ORIENTATION, GENDER (EXPRESSION OR IDENTITY), NATIONAL ORIGIN, ARREST AND CONVICTION RECORDS, DISABILITY, VETERAN STATUS OR ANY OTHER CHARACTERISTIC PROTECTED BY LAW. POSITIONS LOCATED IN SAN FRANCISCO AND LOS ANGELES, CALIFORNIA WILL BE ADMINISTERED IN ACCORDANCE WITH THEIR RESPECTIVE FAIR CHANCE ORDINANCES. ROSE INTERNATIONAL HAS AN OFFICIAL AGREEMENT (ID #132522), EFFECTIVE JUNE 30, 2008, WITH THE U.S. DEPARTMENT OF HOMELAND SECURITY, U.S. CITIZENSHIP AND IMMIGRATION SERVICES, EMPLOYMENT VERIFICATION PROGRAM (E-VERIFY). (POSTING REQUIRED BY OCGA 13/10-91.)