Senior Claims Examiner: Kern Health Systems

The candidate for this position will be responsible for reviewing and processing medical claims from contracting and noncontracting providers and from subscribers and enrollees for payment in an accurate and timely manner. Responsible for review and investigation of COB information and calculation and recovery of COB overpayments. Responsible for research of CCS eligible members and seeking recovery of CCS overpayments. Research and respond to disputes from providers. Process refunds, reversals and perform quality audits using organizational policy and KHS guidelines. Requirements for position are High School diploma or GED. Minimum of 4 years in medical claims payment processing experience. Emphasis on COB and subrogation claims processing. HMO claims payment processing is highly desirable. Must type 45 wpm. Typing certificate required. Working knowledge and real time experience with Word and Excel; medical terminology, ICD-9/CPT coding; COB's, and Medicare guidelines and claims processing, including CCS guidelines.