Claims Processor

Job ID: 106324 Date posted: December 02, 2020

Sharp HealthCare
PFS Claims Processing
Business Operations Jobs
Day Job
Full-Time

Apply now

Responsibilities

Summary

The Claims Processor will do adjudication of referral claims and all related functions.

Department is comprised of 5 claims processing units that process HMO claims for 3 medical groups and Sharp Health Plan.

Sharp System Services have campuses located in the communities of Kearny Mesa and Serra Mesa and consist of the Spectrum location, the Ruffin Road location and Sharp Operations Center (SOC). These offices provide the centralized integrated system support services to the operating entities within the system. These services include: Strategic Planning, Business Development, Information Technology, Compliance, Internal Audit, Legal, Risk Management and Insurance, Contracts, Human Resources, Facilities Management and Development, Clinical Effectiveness, Finance, Nursing, Systems Supply Chain Services, Marketing and Communications, The Sharp Experience and Sharp University.

Location

This position is located in Kearny Mesa, San Diego County

Hours: 8 am - 430 pm with weekends as needed

Required Skills and Qualifications

One-year previous claims processing experience in an HMO or indemnity insurance setting (HMO preferred).
Knowledge of standard insurance procedures (pricing, exclusions, etc.)Strong organizational skills.
Working knowledge of medical terminology and RVS/CPT/ICD-9 coding.
Ten key by touch.
CRT keyboard skills.
Good verbal and written skills.

Preferred Skills and Qualifications

High school graduate or equivalent.
Some college.

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, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.