Medical Payment Examiner
Wawanesa - San Diego, CA

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Medical Payment Examiner-San Diego, CA

Functional Area: Claims
Location: CA-San Diego

Position Type: Full Time
Education Required: Diploma

Experience Required : 1-2 Years
Relocation Provided: None
Who We Are "Operating 116 years strong and growing!"

Wawanesa General Insurance Company is a wholly owned subsidiary of the Wawanesa Mutual Insurance Company of Canada that was founded in 1896. Wawanesa General Insurance markets preferred personal lines automobile and homeowners insurance directly to consumers in California and Oregon through direct mail solicitations, with strategic implementation of radio and newspaper advertising. With almost 600 employees, the US Headquarters of Wawanesa General Insurance is located in San Diego, California.

Wawanesa strives for job satisfaction which has been proven by being ranked "Highest in Customer Satisfaction among Auto Insurers in California" by J.D. Power and Associates.

Known for our conservative approach, Wawanesa offers its employees stability and opportunity to grow in the insurance industry by providing promotional opportunities and the chance to extend ones education through our Tuition Reimbursement Program.

At this time, Wawanesa General Insurance is looking for a service driven Medical Payment Examiner in San Diego, CA.

Position Overview Under the guidance of the Medical Payment Supervisor, the Medical Payment Examiner will be responsible for confirming coverage, investigating, and evaluating Medical Payment claims. The Examiner will determine the medical necessity and reasonableness of medical treatment, audit medical bills for usual and customary fees, and process the claim in accordance with policy provisions, DOI and Statutory requirements.

The Medical Payment Examiner's responsibilities include:
  • Confirm coverages on all files.
  • Determine if primary health care or auto insurance is available and/or applicable.
  • Obtain and review all forms, bills, and health insurance documents to coordinate benefits.
  • Determine if treatment is reasonable and necessary.
  • Audit and adjust medical bills for excessive fees.
  • Maintain a diary system and respond to all mail in accordance to company standards and DOI guidelines.
  • Communicate with doctor or attorney regarding treatment and injuries resulting from accident under investigation.
  • Be able to identify UM, UIM, and BI exposures.
Our ideal candidate will possess the following qualifications:
  • A minimum of one year liability claims handling experience a must.
  • Knowledge of medical terminology, anatomy, and billing is helpful.
  • Working knowledge of auditing, billing, and accounting procedures.
  • Ability to research, analyze, and interpret complex data and information.
  • Ability to perform tasks with a high level of accuracy and attention to detail.
  • Strong organizational skills and ability to have multiple projects going at the same time.
  • Strong communications skills, both verbally and written, including to external customers and within the team.
  • Demonstrate dependability, punctuality, and reliable attendance.
How To Apply If you are ready for a challenging and rewarding career and feel your qualifications match the requirements for this position, please submit a Resume and Cover Letter to .

Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by the employee in this position. The above description is only a summary of the typical functions of the job, not an exhaustive or comprehensive list of all possible job responsibilities, tasks, and duties. Additional duties, as assigned, may become part of the job function.