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Claims Examiner II

CommonSpirit Health
Bakersfield, CA Full Time
POSTED ON 1/27/2025
AVAILABLE BEFORE 3/26/2025
Requisition ID 2024-388888
Employment Type Full Time
Department Claims Processing
Hours/Pay Period 80
Shift Day
Weekly Schedule Monday - Friday, Day and evening shifts available
Remote Yes
Category Managed Care
Overview


The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.


Responsibilities


Under the guidance and supervision of the Manager of Claims, the Claims Examiner II is responsible for the efficient and accurate processing of healthcare claims. This role involves reviewing, analyzing, and adjudicating claims to ensure compliance with applicable policies, procedures, and regulations. The Claims Examiner II will handle complex cases, resolve discrepancies, and provide exceptional customer service to internal and external stakeholders.


Qualifications


Minimum Qualifications:

  • Minimum of 2-4 years of experience in healthcare claims processing or a related field. Experience with managed care organizations (MCOs) or MSOs is highly desirable.
  • Associate’s Degree - Associate's degree in healthcare administration, business, or a related field. Equivalent work experience may be considered.

Preferred Qualifications:

  • 4-5 years experience in healthcare claims processing or related field
  • Proficiency in claims processing systems and software.
  • Strong knowledge of CPT, ICD-10, and HCPCS coding.
  • Excellent analytical and problem-solving skills.
  • Attention to detail and accuracy.

**Medi-Cal experience is preferred.

***Day and evening shifts available.

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.


Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible employees may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit https://www.commonspirit.careers/benefits.

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