Claims Assistant (Temporary- 9 Months)

Salary Range: $45,760.00 (Min.) - $45,760.00 (Mid.) - $52,024.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles Countys vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

This is an onsite position.

The Claims Assistant supports the handling and routing of all documents received through the claims mailroom and the scanning of all paper claims into an electronic format. The Claims Assistant is responsible for opening, accurately counting, sorting the claims by claim type and prepping the claims for scanning. This position assists with scanning of all paper claims and documents into an electronic format. The Claims Assistant enters data for tracking.

Duties

Processes incoming mail: Opens and dates stamp the mail; Sorts and counts mail receipts; Scans claims into electronic document; Tracks claims receipts and apprises the department manager of high volumes; Forwards misdirected mail to the correct entity; Ensures paper claims and nonstandard documents are routed appropriately to our Plan Partners and internal departments within the required timeframe. All incoming mail are counted, date stamped, and given to the correct party within 24 hours of receipt. (55%)

Photocopies and mails correspondence to internal departments, Plan Partners, submitting providers, Participating Physician Groups (PPGs), members, and other parties on a daily basis. Scan/ Optical Character recognition (OCR) of paper claims and verification process. Dispositions of mail and claims within 3 to 5 working days of receipt by the department. Scanned/OCRd claims data has been verified against the document images. (15%)

Maintains the filing system within the department. All claim related information must be filed within seven working days. Files will be monitored to coordinate moving information to off-site storage. (10%)

Answers phone inquiries, provides clerical assistance to the claims department as needed, and orders supplies. Determines workloads and process flows to ensure compliance with the regulatory agencies. (10%)

Performs other duties as assigned. (10%)

Duties Continued

Education Required

High School Diploma/or High School Equivalency Certificate

Education Preferred

Experience

Required:

At least 6 months of mailroom, data entry and clerical experience in a healthcare/managed care environment.

Skills

Required:

Must be very detail oriented with the ability to count accurately and track claim documents throughout the mailroom process.

Proficient in Microsoft Excel with ability to create calculations and charts.

Must be proficient in using Microsoft Word.

Must be able to work effectively within the mailroom by mentoring and coaching mailroom staff on correct procedures.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including

• Medical, Dental and Vision
• Wellness Program
• Paid Sick Leave