Community Hospital of the Monterey Peninsula
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Claims Analyst - Coastal - Coastal TPA
at Community Hospital of the Monterey Peninsula
Aspire Health Plan
M - F 8AM - 5PM
Claims Analyst - Coastal
· Excellent Pay and Generous Benefits including Medical, Dental, Vision, 401k and PTO
· Continuing Education Allowance
· Team Oriented Culture
- Process medical, dental, and vision claims
- Code medical procedures, diagnoses and supplies
- Coordinate benefits with other group health plans
- Interpret plan documents and apply plan benefits based on that interpretation.
- Verify eligibility and authorization
- Refer appropriate claims, pre-certifications and appeals to management and/or medical review
- Request necessary documentation from providers and/or insureds
- Assist in the investigation of possible fraudulent claims
- Investigate injury cases for third party liability or workers' compensation
- Perform other duties and functions as assigned
Experience/Skill Set required:
- Experience in the processing of health insurance claims or equivalent practical experience in a medical office
- Knowledge of medical terminology, insurance billing and coding
- Ability to operate software programs and computer equipment required to fulfill position responsibilities
- Ability to problem solve
- Able to work in a team environment.
- Able to conduct oneself in a professional manner
- High school diploma or equivalent
Aspire Health Plan is a locally owned Medicare Advantage HMO that provides comprehensive medical coverage to seniors and other Medicare recipients in Monterey County. We're proud to be a community-centered organization backed by Community Hospital of the Monterey Peninsula and Salinas Valley Memorial Hospital. Over 700 doctors, many other healthcare providers, and all four Monterey County hospitals are part of the Aspire Health Plan network. It's the care you need from people you know.
Equal Opportunity Employer