Motion Picture Industry Pension & Health Plans (MPI) is looking for a Lead Medical Claims Examiner to join our Medical Claims team! The Lead Examiner is responsible for the timely and accurate processing of PPO medical claims for the Plan’s Participants, specializing in claims that require an elevated amount of research, compiling and analyzing data to identify trends, and developing / mentoring other members of the team.

Qualifications:

• Minimum high school diploma or GED required, some college preferred.
• Three or more years of current claims processing experience preferred.
• Experience mentoring and developing others preferred.
• Excellent understanding of claims procedures, rules & guidelines, and all aspects of claims adjudication (e.g. Coordination of Benefits rules, multiple surgeries, lab/radiology, etc.)
• Advanced understanding of health plans operations, including Medicare.
• Advanced knowledge of Medical Terminology.
• Advanced knowledge of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS).
• Advanced knowledge of International Classification of Diseases (ICD).
• Ability to analyze and identify trends, creating reports as necessary.
• Intermediate computer skills, including Windows and Microsoft Office products, with particular strength in Excel preferred.
• Strong organization skills, with neat work product, and strict attention to details.
• Strong time management skills.
• Ability to thrive in a fast paced production oriented environment.
• Ability to maintain and safeguard confidential information.
• Clear and effective oral and written communication skills.
• Ability to work with individuals at all levels of the organization.
• Excellent attendance and reliability, with the ability to work overtime/extended hours as required.
• Ability to accept direction and developmental guidance from supervisor.

Your responsibilities would include:

• Process medical claims and all associated tasks in accordance with Plan guidelines.
• Actively execute appropriate claims activities to ensure consistent quality / configuration of claims processing.
• Analyze data to identify trends and provide reports as needed.
• Perform investigation / research as needed for the processing of medical claims.
• Process and adjust complex / technically difficult claims.
• Collect and compile monthly audit data for interdepartmental communication.
• Test configuration and system updates as needed.
• Provide coaching and guidance to members of assigned team.
• Meet production and quality assurance goals/standards.
• Perform other duties as assigned.

Job Type: Full-time

Pay: $26.46 per hour

Benefits:

• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

COVID-19 considerations:
All employees are required to be fully vaccinated against Covid-19. Workspaces are socially distanced and high touchpoint areas are sanitized frequently.

Ability to commute/relocate:

• Studio City, CA 91604: Reliably commute or planning to relocate before starting work (Preferred)

Work Location: One location

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