San Diego, CA 92123Claims ProcessorPay Rate:- $17/HR3 months and possible extensionUS Citizen and Green Card Holders ONLY Claims Processor (Examiner) II The primary purpose of this position is to examine & process claims from the UB04 & CMS-1500 claim forms into the claims adjudication system for all capitated & shared services accounts. This position is responsible for the accurate review, input & adjudication of claims using reasonable payment policies & methodologies that are consistent with & recognized by Health Plans, nationally recognized medical organizations, federal regulatory bodies, & contractual obligations of the organization. School Education • H.S. Diploma,GED,or Equivalent (Minimum) Experience • 2 Years of Experience (Minimum) • 3 Years of Experience (Preferred) Quality • Process claims accurately & efficiently in accordance to payment policies & procedures. • Maintains production standard; general productivity is expected to be per day in accordance with department metric standards. • Reviews all incoming claims to verify eligibility, benefits, & authorization information according to department guidelines. • Makes appropriate edits, changes, & corrections to inloaded claims in the system to ensure accurate & timely payment of claims as defined by leadership. • Specific Essential Function :Generate the appropriate denial letters and/or reports based on established criteria; Reconcile daily, weekly, monthly reports in a timely manner as defined by dept guidelines. • Inload daily/weekly EDI files; generate and/or reconcile EDI reports per department guidelines. • Identify Third Party Liability (TPL) claims & notify/submit to recovery agent for possible recoveries in accordance with department guidelines. • Act as a backup in generating weekly check run & corresponding Explanation of Payments (EOP-s).