Claims Processor

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    La Palma, CA, 90623
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    ST, Healthcare
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    Contract - Full Time
Specific Duties
• To batch and prioritize claims processing utilizing the Company’s in-house claims processing system.*
• To verify patient’s accounts for eligibility and benefits.*
• To accurately process complex claims that have been accepted for payment.*
• To request and follow-up on additional information as needed for incomplete claims.*
• To complete all steps above within designated timeframes (production quotas) and notify management if claims cannot be processed within the designated time frame.*
• To assemble denial letter background information and generate denial letters.*
• To read, interpret and summarize medical contracts/division of responsibility.
• To identify claims that is not our financial risk and forward to appropriate entity for payment.
• To review claims that is pending and follows through for payment in a timely manner.
• To treat peers, superiors, subordinates clients and vendors with fairness, courtesy and professionalism and contribute to the overall positive work environment of the department.
• To complete other production projects as assigned.
• To have the ability to process both IPA and Hospital claims.

Must have qualifications/experience:
• Requires the ability to speak, read, write and understand English and other general educational skills as is generally obtained by completing high school or a GED.

• Requires 4+ years claims adjudicating experience preferably in a managed care setting.


Shift Start/End Time: 7:30am to 4:oopm

Dress Code: Business Casual
Benefits
At Maxim Healthcare Group, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
  • Competitive pay & weekly paychecks
  • Health, dental, vision, and life insurance
  • 401(k) savings plan
  • Awards and recognition programs 
*Benefit eligibility is dependent on employment status. 
**CO Specific Benefits: Medical/Prescription, Dental, Vision, Health Advocacy (company paid if enrolled Medical), Health Advocate Employee Assistance Program, Health Savings Account , 401(k), 401(k) Company Match, Profit Sharing, Short Term Disability, Long Term Disability, Primary Caregiver Leave, Parental Leave, Life and Basic Accidental Death & Dismemberment Insurance, Voluntary Life and Accidental Death & Dismemberment Insurance, Hospital Expense Protection Plan, Critical Illness Insurance, Accident Insurance, Dependent Care Flexible Spending Account, Home and Auto Insurance, Pet Insurance, Transportation Benefits, CommonBond, Educational Assistance Program, College Partnership Program, Paid Time Off/Company Holidays

About Maxim Healthcare Group
Maxim Healthcare Group has making a difference in the lives of our patients, caregivers, and employees for more than 30 years. Our nationwide suite of services includes home healthcare, companion and behavioral care, healthcare staffing, and workforce solutions. Maxim’s commitment to customer service, compassionate patient care, and filling critical staffing needs makes us a trusted partner wherever healthcare is needed.  

Maxim Healthcare Group is an Affirmative Action/Equal Opportunity Employer

What to Expect

Our checklist will walk you through updates in your applicant experience.

  1. Submit an Inquiry
  2. Submission Review
  3. Follow-Up by Recruiter
Maxim Healthcare is an Affirmative Action/Equal Opportunity Employer.

Please click here to view our EEO and AAP policy.