Hybrid CSR-Processor

Job Details Job Location: DHS Remote - Stockton, CA 95219 Position Type: Full Time Salary Range: $20.25 - $20.25 Hourly Job Category: Admin - Clerical Delta Health Systems, one of the leading Third Party Administrators (TPA) for self insured programs in the country with a reputation for flexibility, innovative services and outstanding customer service is looking for an innovative, self motivated, dedicated individual to fill the position of: Claims Processor / Customer Service Rep. POSITION RESPONSIBILITIES • Evaluate claims and determine payment or denial according to Plan provisions, Medical Policy and Department guidelines • Key all final information for claims release into computer • Respond to telephone customer inquiries verifying eligibility, explaining coverage, quoting benefits and advising on the status of claims • Maintain information files, worksheet records, benefit quote documentation • Establish and maintain COB files, applies COB payments for final claim payment • Research and determine proper CPT procedure and ICD-9 Diagnosis Codes • Research and respond to written correspondence from participants, providers, and local unions/employers • Prepare transmittal and send claims to Benefit Review for processing instructions • Work effectively to achieve acceptable production and accuracy standards • Display maturity, composure and ability to operate under stress conditions • Perform other duties as assigned • Specialty duties include: Enter dates of service on dental pre-determinations. Process voided checks and refund checks. Maintain weekly disability files and process claims. KNOWLEDGE AND SKILL Eighteen (18) months experience as a Claims Processor or similar function. Must have a broad knowledge of medical terminology and must possess excellent written and oral communication skills. Must possess good judgment skills and ability to interpret Department guidelines and contractual benefits and possess a high school diploma or equivalent. Satisfactory completion of medical terminology course may substitute for six (6) months of equivalent experience. Delta Health Systems is committed to long-term growth, employee development and superior client service. Join a great team with terrific total comp package. Equal Opportunity Employer Qualifications Delta Health Systems is committed to long-term growth, employee development and superior client service. Join a great team with terrific total comp package. Equal Opportunity Employer Apply tot his job