Claims Approver
- Employer
- Keenan & Associates
- Location
- Torrance, California
- Salary
- NA
- Posted
- Jun 20, 2018
- Closes
- Aug 19, 2018
- Category
- Claims
- Job Type
- Full Time
- Career Level
- Not Specified
Keenan & Associates is a successful insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services for employee benefits, workers' compensation, loss control services, Keenan Financial Services, and property & liability to school districts and hospitals throughout California. We have seen continuous progress and expansion, making us the 18th largest consulting firm in the United States. This growth positions us to continue to lead the industry into the 21st century.
We currently have an exciting career opportunity for a Claims Approver located in our Torrance office. The Claims Approver is responsible to investigate and process group medical and dental health claims accurately and expeditiously according to the Plan of benefits and contract provisions.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
- Determine claim payments based on eligibility of benefits, eligibility of participants, Plan provisions, pre-existing conditions, coordination of benefits, and mandated benefits
- Investigate claims through the use of letters to plan participants, providers, group administrators, other insurance carriers, agents or brokers to properly adjudicate the claim
- Enter all pertinent information into claims system for claim processing
- Document each claim with appropriate letters, telephone documentation, system employee notes and diary and cross reference the documentation
- Meet quality and quantity standards as established by the Benefit Claims Department
- Process adjustments to revised claims
- Enter Utilization Management information in system
- Communicate in a courteous and professional manner to Plan participants, employers, co-workers, providers, etc
- Other duties as assigned
MINIMUM SUGGESTED QUALIFICATIONS:
Prior claims processing experience is required. HIAA, Medical Terminology, additional education and/or related experience helpful. Knowledge of stop loss contracts and self-funded plans is preferable. Knowledge of medical and dental terminology is preferable. Medical coding (ICD-9 and CPT) background helpful. Basic math skills essential, as well as the ability to collect data, establish facts and draw conclusions of technical, medical and dental terms. Must have excellent keyboarding, written and verbal communication skills. Must be proficient in Outlook and Microsoft Windows.
Keenan provides a competitive compensation and benefits package. We encourage teamwork and employee initiative - people working together is what makes Keenan a success. We invite you to share in the commitment of preserving our warm tradition, reputation and dedication to our clients. After all…What you do makes a difference!
Keenan provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, veteran, marital, or domestic partner status. Keenan is committed to a diverse workforce and is an affirmative action employer.