Cedars-Sinai · 17 hours ago
Claims Examiner - Managed Care
California, United States
Full-time
Onsite
Mid Level
$24/hr - $33/hr
3+ years expCedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. The Claims Examiner is responsible for accurately and consistently adjudicating claims in accordance with policies, procedures and guidelines, processing claims according to CMS and DMHC guidelines, and meeting production and quality standards.
CommunitiesHealth CareMedicalNon Profit
Responsibilities
Responsible for efficiency standards for number claims completed and for accuracy of entries
Handles in a professional and confidential manner all correspondence
Supports core values, policies, and procedures
Acquires and adjudicates medical claims for processing; reviews scanned, EDI, or manual documents for pertinent data on claim for complete and accurate information
Acquires daily workflow via reports or work queue and incoming phone calls
Research claims for appropriate support documents
Analyzes and adjusts data, determines appropriate codes, fees and ensures timely filing and contract rates are applied
Responds and documents resolution of inquiries from internal departments
Assists Finance with researching provider information to resolve outstanding or stale dated check issues
Performs Provider Dispute Request (PDR) fulfillment process from the point of claim review through letter processing and records outcome in applicable tracking databases
Qualification
Required
Three (3) years of medical claims processing for Medicare and Commercial products and provider dispute resolution processing in an IPA, HMO and Hospital related setting required
Three (3) years of experience with processing all types of specialty claims such as Chemotherapy, Dialysis, OB and drug and multiple surgery claims required
Preferred
Three (3) years of experience on an automated claims processing system (Epic Tapestry preferred)
Company
Cedars-Sinai
Since its beginning in 1902, Cedars-Sinai has evolved to meet the healthcare needs of one of the most diverse regions in the nation, continually setting new standards for quality and innovation in patient care, research, teaching and community service.
10001+ employees
H1B Sponsorship
Cedars-Sinai has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (105)
2024 (91)
2023 (81)
2022 (92)
2021 (92)
2020 (65)
Funding
Current Stage
Late StageTotal Funding
$63.31MKey Investors
American Academy of Orthopaedic SurgeonsCalifornia HealthCare FoundationNational Heart, Lung and Blood Institute
2023-12-01Grant· $0.01M
2023-05-25Grant· $28M
2022-06-16Grant· $7M
Leadership Team
Thomas Priselac
President/CEO
David Wrigley
Executive Vice President Finance, CFO and Treasurer
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