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Claims Examiner II APPLY ONLINE

Location(s): Brockton / Riverside

Status: Full-time

Department: HMO Claims


Responsible for preparing, researching, analyzing, pre-coding and the adjudication of all types of claims (Contracted providers, Non-contracted, 1500 or UB claims forms, Senior and Commercial plans) received at Riverside Medical Clinic from outside providers for processing. Managed Care claims are processed in accordance with the outside Provider Contract, State, Federal, CMS, DMHC and Health Plan guidelines and regulations. Must maintain a processing standard of 10 claims per hour with a 90% level of accuracy, both clerical and financial. High school diploma or GED required. Three or more year’s related experience and/or training; or equivalent combination of education and or experience.

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