The Claims Processor II, will be responsible for processing specialty and ancillary service claims, specific to contract agreements and Health Plan Division of Financial Responsibility’s (DOFR’s). Duties also include verifying patient account, eligibility, benefits and authorization information; analyze the information to determine payment amount or denial of payment.
Sharp Health Plan is the largest locally based commercial health plan in San Diego. We are a not-for-profit health plan that has been serving San Diego and southern Riverside Counties since 1992. As a subsidiary of Sharp HealthCare, we are backed by the largest provider of comprehensive health care services in San Diego.
Sharp Health Plan offers a variety of coverage options that combine affordability and choice, while delivering high quality health care and personal service. We provide health insurance for companies of all sizes throughout the region. Members have access to valuable plan enhancements, such as interactive wellness resources, dental discounts and our exclusive global emergency services program.
Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.
This position is located in Kearny Mesa, San Diego County.
Full Time, Day Shift
Required Skills and Qualifications
- High School Diploma required. Please include this information under the education section of the application.
- Minimum 4 years of experience in Managed Care (HMO, Medicare, Covered California, Medi-Cal) with demonstrated performance that consistently exceeds expectations
- Proven knowledge of CPT, HCPCS, ICD-9/ICD-10, DRG’s, RBRVS codes and medical terminology for both electronic and paper claims
- Proven knowledge of processing Provider Dispute Resolutions
Preferred Skills and Qualifications
- Some college preferred
- Medical Terminology