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Insurance Benefits Specialist
7370 N Palm Ave Fresno, CA 93711 US
Job Description
Job Title: TPA Adjuster (Plan Auditor)
Employment Type: Full-Time / Temp-to-Hire
Pay Rate: $20-23Â per hour
Location:Â Fresno, CA
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Immediate Opening: We are seeking a TPA Adjuster to join our team with a focus on conducting plan audits of Anthem Blue Cross insurance. We aim to interview this coming week and have the right candidate start by the following Monday.
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Job Summary: As a TPA Benefit Auditor, you'll be responsible for overseeing the day-to-day maintenance of plans, providers, and benefits. This role involves maintaining system files, ensuring accuracy, conducting periodic audits, and resolving benefit routes within the cutomized system.
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Key Responsibilities:
- Maintain system files related to benefits, providers, and PPO parameters.
- Create and update new groups, plans, divisions, and benefits in the healthcare system.
- Maintain CPT/HCPC codes, fee schedules, and plan-related documentation.
- Conduct audits to ensure file accuracy and provide feedback on trends and areas for improvement.
- Address issues promptly and collaborate with the team to complete tasks efficiently.
- Help with plan audits for areas of possible benefit plan appeals to reprocess underpaid claims
Qualifications:
- High School Diploma or GED required.
- Minimum of 3 years of medical claim processing experience in an PPO/TPA setting.
- Familiarity with medical terminology, CPT, RVS, ICD-10 codes, and Microsoft Office Suite.
- Strong communication skills and the ability to evaluate queries and reports.
Physical Requirements:
- Ability to sit for long periods.
- Some bending, stretching, and reaching required.
- Proficiency in operating office equipment like a keyboard, 10-key calculator, telephone, and fax machine.
Why Join Us? This is an excellent opportunity to work in a dynamic environment where you'll play a key role in maintaining and improving our benefit administration systems. If you're detail-oriented, with a solid background in medical claim processing, we’d love to hear from you.
Apply Now: We are looking to move quickly, so please submit your application to be considered for an interview this week!
INDHP HUH
Additional Information
Career Expert
Rebecca Kirkman
President
Rebecca Kirkman is the President and founder of Hire Up Staffing and Hire Up Healthcare. She works hard daily to support our teams with the necessary training and vision in order to elevate our company to being an industry leader for staffing. What people don't know is she started the company when she was 28 years old, with already 5 years of successful staffing experience with a major name in the industry. She has helped countless people and has a true knack for intuitively being able to match people with their best path, whether it be a new job or considering to add to your team. She teaches the team those strategies and pushes everyone to get out of their comfort zone and elevate the way that they think so that they too can reach higher boundaries, then push past those as well!