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Loma Linda University Health

Claims Examiner-FSA/Customer Service

Career Insights for Claims Examiner (General)

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Based on California data

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What they do

A Claims Examiner evaluates insurance claims in accordance with applicable contracts and government regulations within their insurance type. Determines member eligibility and financial responsibility of the insurance company.

$88,344 / year median in California

-7% projected decline

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Job Description

Shared Services:
Risk Management- (Full-Time, Day Shift) -
Job Summary:
The Claims Examiner-FSA/Customer Service role provides information on eligibility, claims status, and employee benefits for Health Plans and FSA Plans administered by Risk Management via phone and email. Coordinates all aspects of the employee Flexible Spending Accounts including processing employee FSA claims. Performs other duties as needed.
Education and Experience:
Associate's Degree preferred. Minimum two years of experience as claims adjuster, medical claims biller, call center or related experience required.
Knowledge and Skills:
Completion of medical terminology course preferred. Able to keyboard 35 wpm and operate 10-key calculator. Able to analyze and interpret data; judge and act on analysis of data; apply mathematics to manipulate/analyze data; analyze and solve specific problems. Able to read, write legibly; speak in English with professional quality; use computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to relate and communicate positively, effectively, and professionally with others; work calmly and respond courteously when under pressure; collaborate and accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.
Licensures and Certifications:
None.