Claims Clerical Assistant
Partnership HealthPlan of California - Fairfield, CA

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POSITION PURPOSE To support all mail, file and scanning functions in the claims department.

  • Breaks down completed batches: verifies and reports routed claims, routes and files
pended claims.
  • Provides overflow support for all mail clerk functions.
  • Reviews batch claims for accuracy and completeness; prepares documents for scanning.
  • Scans claim documents onto disk and indexes scanned claims.
  • Retrieves scanned documents from the retrieval system and pulls paper claims from the paper files and re-files claim documents, as needed.
  • Completes daily productivity worksheets.
  • Copying/refiling.
  • Files and maintains all electronic routes, closed claims files and audit files.
  • Verifies paper claims entry prior to filing closed claims.
  • Prepares closed files for off-site storage.
  • Verifies and prepares closed claims batches for shredding.
  • Verifies outsourced paper claims and reports outcome prior to shredding.
  • Records claim adjustment turnaround times.
  • Prepares and mails outgoing correspondence.

  • Participates in special departmental projects and assignments as required.
  • Serves as backup for Medicare Clerical Assistant
  • Other duties as assigned.


Education and Experience

High School diploma or equivalent; minimum one (1) year general office clerical experience or equivalent combination of education and experience.

Special Skills, Licenses and Certifications

Typing speed 40 wpm and proficient use of 10-key calculator. Knowledge of general office business machines. Basic working knowledge of word processing.

Performance Based Competencies

Ability to understand and follow instructions. Ability to effectively exercise good judgment within scope of authority. Good organization skills with knowledge of alpha-numeric filing systems. Ability to accurately complete tasks within established times.

Work Environment And Physical Demands

Ability to use microcomputer keyboard and scanning equipment for extended periods of time. More than 60% of work time is spent at a video display terminal. When required, ability to move, carry or lift. Objects of varying sizes weighing up to 40 lbs.

All Healthplan employees are expected to:
  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the Healthplan’s policies and procedures as they may from time to time be updated.

IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, education factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The Employer reserves the right to revise this job description at any time and to require employees to perform other

Partnership HealthPlan of California - 7 months ago - save job
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PHC is a managed care organization that contracts with the State of California to ensure that Medi-Cal recipients in Solano, Yolo, Napa,...