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Claims Examiner

agilon health Honolulu, HI
  • Expired: over a month ago. Applications are no longer accepted.

The Claims Examiner I adjudicates health services claims of basic complexity levels. Researches, analyzes, and calculates claims benefits and payments in accordance with the current MDX Hawai‘i rules, policies, procedures and contracts.

  • Basic CMS1500 claims: Capitated and Fee-For-Service physician services i.e. office visits, anesthesia and unknown member and provider claims.
  • Basic CMS1500 claims: Laboratory and Radiology
  • Basic Outpatient UB04 claims: Clinic Visits, Free Standing ASC, Radiology and Laboratory

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Regularly and dependably reports to work as scheduled. Follows all Company policies and procedures, including but not limited to personnel policies, safety policies and operational policies as communicated by management. Follows all Department policies and procedures, including, but not limited to procedural guidelines/workflows, attendance requirements and performance requirements as communicated by management. In accordance with State and/or Federal confidentiality/privacy laws, maintains confidentiality of all company, provider, member and client information as specified by Company confidentiality policies and procedures. Represents the Company in a professional manner at all times when dealing with both internal and external customers. Adjudicates assigned claims based on applicable conditions, including but not limited to, department policies, procedures and workflows, provider contracts and health plan benefits. Assist with researching claims issues referred to the Claim Department. Maintains all claims records.

EDUCATION AND/OR EXPERIENCE: High School Graduate or equivalent One (1) year experience processing medical claims

agilon health

Why Work Here?

Awesome leadership, great benefits, opportunity for growth and putting your stamp on things!

The passion to change the way healthcare is delivered permeates everyone and everything at agilon health. Working together we can use our expertise to make a difference in the lives of patients and physicians alike. We can bring the joy back to practicing medicine for physicians and improve the care experience for patients across the country. We believe that every member of our team plays a critical role in transforming care for our patients. Our customer service teams are the front line for physicians and patients navigating the system and, without our claims processing departments, our health plan partners and provider networks couldn’t do their jobs. No matter what your role is at agilon health, you can and will make a difference in the lives of the seniors and Medicaid populations we serve. Our culture and passion has already been embraced by nearly 500 employees in three states. And we are excited to welcome new members to the team as more physicians and patients experience the difference agilon health can make.

Address

Honolulu, HI
USA

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