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Medical Insurance Claims
Job
AppleOne
Bakersfield, CA (In Person)
Full-Time
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Job Description
Job Summary We are seeking a detail-oriented Medical Insurance Claims professional for a full-time temp-to-hire opportunity in Bakersfield, CA. This hybrid/remote role is ideal for a claims processing professional with payer-side or health insurance claims experience, rather than clinic-only billing experience. In this role, you will review, process, audit, and resolve medical and facility claims for payment while applying contract benefits, policies, procedures, eligibility rules, coding guidelines, and payment standards. You will support accurate, timely, and compliant claims administration within a mission-driven healthcare services environment focused on improving member health. This is a strong opportunity for someone who enjoys focused claims review work, values accuracy, and wants to grow within a stable healthcare organization. The team environment supports collaboration, clear processes, professional development, and access to leadership guidance on more complex claims. This position may be filled at the I or II level based on experience and qualifications. Key Responsibilities
- Review and process medical and facility claims from contracted and non-contracted providers, subscribers, and enrollees.
- Resolve system-suspended claims for PCPs, labs, radiology, less complex specialists, and physical therapy claims.
- Apply benefits, contract terms, claims policies, coding guidelines, and payment procedures accurately and timely.
- Identify billing errors, possible fraudulent submissions, overpayments, CCS eligibility issues, COB concerns, and claims requiring additional review.
- Deny inappropriate claims according to policy guidelines and route complex claims to the appropriate department or supervisor.
- Maintain productivity, quality, documentation, and attendance standards in accordance with department guidelines.