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Claims Processor

Job ID: 106324 Date posted: December 02, 2020

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



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.

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.

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“After nearly 10 years of working here, it's still one of the hardest jobs I've ever loved. If you find a niche here, you'll be working with some of the smartest in the industry. This is where they'll respect you for thinking outside the box and kindness matters. They expect consistency and hard work, but pay you well to do it.”

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