Medical Claims: Senior Examiner

Southern California United Food & Commercial Workers Unions & Food Employers Joint Benefit Funds Administration, LLC (The Funds) were created more than 40 years ago as a result of collective bargaining between the Southern California Retail Food Employers and the Southern California UFCW Union Locals. The Funds serve in excess of 100,000 participants! There are two Funds, the Pension Fund and the Benefit Fund--through which member retirement and health and welfare benefits are provided.

The Funds Office is currently searching for a supportive Medical Claims: Senior Examiner, to join our growing Healthcare Claims Team. In this role, you will be responsible for the operational efficiency and accuracy of medical claims processed by providing support to the staff and supervisor. This position is subject to Collective Bargaining.

General Responsibilities:

1. Assist the Supervisor in the coordination of the Department s daily work assignments
2. First point of contact for departmental issues.
3. Review results of adjuster audits and discuss results and opportunities with Supervisor and staff.
4. Assist in identifying, maintaining and reporting team performance as it relates to quality, production and service standards.

5. Maintain current department knowledge of plan documents, summaries of plan provisions and other plan materials.

6. Provide input and feedback on staff performance.
7. Identify and recommend process improvements for internal workflow, system processes and updates to benefit plans.
8. Professionally and effectively communicate with plan participants, Local Union representatives and employer representatives, in person, on the telephone, email, or US mail.
9. Handle escalated situations with courtesy and professionalism.
10. Provide excellent customer service to co-workers and other departments.
11. Demonstrate appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and the ability to facilitate problem resolution.
12. Perform other job related duties/special projects as assigned.
13. Abide by organizational and HIPAA guidelines, privacy practices, and confidentiality.
14. Comply with the policies of the Trust Fund, as set forth in the Employee Handbook.
15. Adhere to the company s attendance policy.

Qualifications:

• High School diploma or GED required
• Associates degree or a combination of education and experience preferred
• 4-6 years prior experience in medical customer service and claims
• PPO claims processing experience, including prior experience in WGS processing system preferred
• Knowledge of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS), Medical Terminology
• Knowledge with International Classification of Diseases (ICD) ICD-9/ICD-10 codes and guidelines
• Ability to manage multiple projects with various deadlines strongly desired
• Able to utilize MS Office (Excel, Word and Outlook) proficiency required
• Excellent customer service skills with the ability to build rapport with Plan participants, team members and other employees of the Fund

The Funds is an equal employment opportunity employer and no candidate for employment will be rejected on the basis of race, color, religion, national origin, age, marital status, or sex. Candidates with physical impairments or limitations will be considered to the extent it can be reasonably demonstrated that the duties and responsibilities can be effectively performed without endangering the individual, colleagues or surroundings.

The Funds offers exceptional benefit packages that includes a 401(K) plan, pension plan, vacation, holiday, education reimbursement and much more!