Find & Apply For Claims Specialist / Adjuster / Examiner Jobs in Long Beach, California

The Claims Clerk Supervisor leads the daily clerical and claims-support operations of the Claims department, guiding a team of claims clerks through intake, imaging, data entry, adjustment, correspondence, and appeals-support workflows. Working under the Manager of Claims Operations, this role serves as a subject-matter expert on claims reprocessing and clerical procedures, drives quality and payment accuracy, and supports internal audits and compliance readiness. The position operates in a modern, largely paperless claims environment built on electronic claim intake (EDI 837), electronic remittance (835), clearinghouse and health-plan portals, and digital document management. The Supervisor is expected to be comfortable adopting and working alongside AI-based and automation tools — such as intelligent document processing (OCR/indexing), auto-adjudication and exception-queue routing, and AI assistants that help draft correspondence, summarize claim and appeal history, and flag anomalies — while exercising sound judgment, validating tool output, and safeguarding protected health information (PHI) in accordance with HIPAA and company policy.

ESSENTIAL RESPONSIBILITIES & DUTIES

Team Leadership & Supervision Supervise, train, and mentor claims clerks; serve as the subject-matter expert on claims reprocessing and daily clerical procedures. Assign and balance daily workloads, monitor productivity and turnaround times, and ensure end-of-day close-out (batch cover sheets, log sheets, and the end-of-day email) is completed accurately. Communicate effectively with the Claims Manager and production staff, and coordinate with client services, external vendors, health plans, and other organizations to resolve claims issues. Claims Intake, Batching & Document Imaging Oversee claims batching, filing of data-entered claims, and daily retrieval of health-plan files (e.g., pulling claims from the Humana SFTP/FTP and health-plan portals). Manage document imaging in OnBase and the Mail Room Scan Folder, including separation and scanning of multiple medical records (Mult MR), and use of OCR/intelligent document processing to index and route images for processing. Administer fax intake and distribution (RingCentral, fax folders) and ensure all source documents are captured and stored for adjudication. Claims Data Entry & Adjudication Support Perform and supervise data entry of

CMS-1500

(HCFA) and UB-04 (UC) claims into EZ-CAP, and process corrected claims (MEDRVW) to meet turnaround-time standards. Apply adjustment codes, process copay reversals, resolve invalid billing formats / rejected claims and invalid NDCs, and correctly distinguish first-time claims from adjustments (e.g., Anaheim Global MEC vs. first-time claim). Work assigned queues and status codes (e.g., UDUNC, 252, 16), apply PS note codes accurately, and generate member/provider notices using the EOB Writer. Appeals, Grievances & Provider Disputes Support the appeals and grievance (A&G) process: intake of paper and electronic appeals, maintenance of the Appeals Data Entry Log, and pairing appeals with the associated claim image. Forward Provider Dispute Resolutions (PDRs) appropriately (requires working knowledge of the PDR process) and respond to Health Plan Demand Inquiries. Prepare and track development correspondence — 1st and 2nd request letters for developed claims (mailed and email requests) and forwarding of letters for claims denied under B11. Eligibility & Provider/Facility Data Perform eligibility look-ups and submit eligibility verification requests to confirm coverage prior to adjudication. Submit and follow up on provider and hospital add requests to keep provider and facility data accurate. Quality, Auditing & Compliance Audit claims-processing quality; develop, maintain, and run standard and ad-hoc reports to identify root causes and improvement opportunities. Support the claims compliance team in preparing for internal and external audits; research and document special conditions or additional requirements affecting adjudication. Monitor paper claims submitted and reconcile intake against system totals. Technology, AI Tools & Continuous Improvement Use standardized processes, tools, templates, and productivity software (Microsoft 365, Teams) to manage projects, timelines, and issue tracking; submit and follow up on Help Desk tickets. Adopt and champion AI-based and automation tools that improve speed and accuracy — always reviewing and validating AI-generated output before it is relied upon, and never entering PHI into non-approved tools. Participate in special claims projects (including STAR/annual-wellness claim processing) and recommend workflow improvements. Perform other duties as assigned.

EDUCATION & EXPERIENCE REQUIREMENTS

High school diploma or GED required; associate's degree (or equivalent coursework) in healthcare administration, business, or a related field preferred. Four to six years of healthcare claims processing / claims operations experience, including at least one to two years in a lead, senior, or supervisory capacity. Working knowledge of Medicare, Medicaid, and Commercial claims-processing guidelines; managed-care / IPA or delegated-claims experience preferred. Proficiency with

CPT, HCPCS, ICD-10-CM

coding and RBRVS methodology; a coding credential (e.g., CPC, CCS) is a plus. Revenue-recovery experience is a plus. Experience with a claims administration platform such as EZ-CAP and a document-management/imaging system such as OnBase (Hyland) is strongly preferred. Comfortable learning and using AI-assisted and automation tools in a claims setting, with good judgment about validating output and protecting

PHI. KNOWLEDGE, SKILLS & ABILITIES

Strong knowledge of claims-processing rules, guidelines, and clerical workflows; high accuracy and attention to detail. Highly organized, able to prioritize and perform multiple tasks efficiently in a fast-paced, deadline-driven environment. Computer literate and quick to learn new systems; proficient with Microsoft 365 (Outlook, Excel, Teams), electronic fax, SFTP/portals, and document imaging. Clear written and verbal communication; able to work effectively with all levels of staff, providers, and health plans. Sound judgment handling PHI; commitment to HIPAA compliance and data security.

AMM BENEFITS

When you join AMM, you're not just getting a job—you're getting a benefits package that puts YOU first:

Health Coverage You Can Count On:

Full employer-paid HMO and the option for a flexible PPO plan.

Wellness Made Affordable:

Discounted vision and dental premiums to help keep you healthy from head to toe.

Smart Spending:

FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.

Work-Life Balance:

Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.

Career Development:

Tuition reimbursement to support your education and growth.

Team Fun:

Paid company outings and lunches because we work hard, but we also know how to have fun!