Claims Data Entry Clerk II

Salary Range:  $45,760.00 (Min.) - $47,823.00 (Mid.) - $55,818.00 (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 County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Claims Data Entry Clerk II is responsible for the accurate and timely data entry of claims and other documents, which includes: Keying claims for all lines of business, including complex claims. Data Entry of Claims in Core adjudication system. Checking the eligibility of members of services in order to sort claims by product. Scanning and sorting medical records. Reviewing claims for required information, returning claims to the provider when necessary. Preparing reports and ensuring that reports are accurate and generated within specified timeframes.

Duties

Creates and sends Rejection letters to the providers for the rejected Claims with 98.5% accuracy. Follows L.A. Care (LAC) policies and procedures. Keeps current with incoming daily receipts. Meets production standards. (50%)

Accurately sorts based on department procedures. Keeps current with incoming daily receipts. (25%)

Performs special projects and ad-hoc reporting as necessary. Projects are complete and reports are generated within the specific time frame agreed upon at the time of assignment. (15%)

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 accurate, high-volume claims data entry or claims processing experience.

Preferred:
Managed care or Medi-Cal claims experience.

Skills

Proficient in Microsoft Office

Strong verbal and written communication skills

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Preferred:
Claims Examiner 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

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)

Nearest Major Market: Los Angeles
Job Segment: Data Entry, Claims, Clerical, Administrative, Insurance