Claims Examiner

Company Overview

Personal Insurance Administrators, Inc. is a leading third-party claims administrator in the student health insurance industry specializing in college and university health insurance plans.  We are located in Agoura Hills, California and are seeking an experienced Claims Examiner to provide quality service to our customers.

 

Job Description

As a claims examiner you will be assigned a group of schools and have the responsibility to pay claims for the insureds of those schools.  You will be responsible for ensuring that all the necessary administrative forms and medical records have been received; that the system is coded with the proper ICD-9, CPT, and benefit codes; repricing is performed; and that all other procedures of the claim adjudication process are performed accurately and in a timely manner.  You will also be a primary contact for your assigned schools, which requires that you possess excellent telephone skills. You will be responsible for ensuring that all performance guidelines are met or exceeded, including timeliness and quality standards.

 

Qualifications

To be considered for this position you must meet all the following qualifications:

 

?  5+ years experience as a claims examiner in either the student health insurance or the fully-insured health insurance industries working with PPO networks. 

?  Extensive knowledge of ICD-9, CPT coding, and payment calculations, and ability to pay complex claims. 

?  Strong investigation skills and experience with processing pre-existing claims and coordination of benefits.

?  Be a self-starter with excellent organization, communication, and customer service skills. 

?  Be a team player.

 

 

We offer competitive compensation with benefits, including health, dental, and 401K.

 

We will only be reviewing resumes from local candidates only who have a health insurance background.

 

If you are a qualified candidate, please submit your resume and salary history to:

 

Email: jobs@pia-inc.com

Fax:    818-735-6996