The Claims Adjuster is responsible for adjudicating claims of a CMS 1500 form and UB04. The Claims Adjuster is responsible for reviewing and processing claims, determining eligibility and Division of Financial Responsibility according to the Health Plan matrix. Responsible for processing Provider Dispute Resolutions, review and processing of underpayments, and processing of refunds due to overpayments.
The ideal candidates will have a minimum of 3 years medical claims experience, knowledge of Medicare policies, CPT/ICD-(9)10 coding, Medical terminology and diagnosis, strong PC skills, analytical, data entry, typing.
High School Diploma or equivalent - required
AA Degree - preferred
Internal Number: SEA000083
About Seaside Health Plan
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.