Experience Inc. Jobs

Overview

*Required On-site training in Campbell, CA (Beautiful Bay Area!) for a week.

BroadPath is hiring a detail-oriented Senior Claims Examiner looking to make a significant impact in the healthcare industry. Join our team as a Senior Claims Examiner and play a crucial role in ensuring the financial health of our organization while supporting quality patient care. The Senior Claims Examiner's primary function is to ensure the accurate adjudication of all complex claims for SCCIPA contracted plans. Your expertise will be crucial in maintaining our high standards of accuracy and efficiency in claims processing.

Responsibilities

• Adjudicate all types of claims, resolving system edits and audits for both hardcopy and electronic claims.

• Address provider and eligibility issues related to received claims.

• Generate emergency reports and authorizations for claims lacking prior authorization.

• Process third-party liability and coordination of benefit claims in accordance with company policy.

• Review stop loss reports and identify members approaching reinsurance thresholds.

• Identify potential system programming issues and report them to the supervisor.

• Provide technical support and training for claims processors.

• Recognize and appropriately route claims for carved-out services according to plan contracts.

• Apply knowledge of plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans, and capitation arrangements in claims processing.

• Understand general ledger accounts and post claims information to appropriate accounts.

• Collaborate with Customer Service and Provider Services on large claim projects and adjustments.

• Assist with benefit and plan interpretation for customers using the cut-log system when necessary.

• Adjust complex claims and provide support to other examiners.

• Perform other duties as assigned.

Qualifications

• Excellent communication skills with supervisors and co-workers

• Strong analytical skills to address claim issues and troubleshoot problems

• Ability to thrive in a high-volume, production-oriented environment

• Detail-oriented with the capacity to maintain focus for extended periods

• Capability to work under demanding performance standards for production and quality

• Proficiency with claims processing software

• Ability to understand and implement complex claims procedures

• Knowledge of medical terminology

• Familiarity with HEDIS, DOC, HCFA, and NCQA requirements

• Capacity to serve as a resource and/or trainer for claims processors

Education

• High school diploma or equivalent required

Experience

• Three to five years of experience processing regular and complex claims

• Knowledge of ICD-9, CPT, HCPC, and Revenue Coding required

Must be available for a minimum of 7 days of travel.

On-Site Training: This role requires on-site training in Campbell, CA.

Diversity Statement

At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!

Equal Employment Opportunity/Disability/Veterans

If you need accommodation due to a disability, please email us at HR@Broad-path.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process

BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law.

Compensation: BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.