Medical Claims Examiner

Medical Claims Examiner at Ultimate Staffing Services Medical Claims Examiner at Ultimate Staffing Services in Pasadena, California Posted in 6 days ago. $24.00 - $31.00 per hour

Job Description:

Job Title:

Medical Claims Examiner Overview:

We are seeking a detail-oriented Medical Claims Examiner with 3-5 years of experience to review, evaluate, and process healthcare claims in accordance with plan guidelines, policies, and regulatory requirements. This role plays a key part in ensuring accurate and timely claims adjudication while maintaining compliance and high service standards.

Key Responsibilities:

Review and adjudicate medical claims for accuracy, completeness, and eligibility based on plan benefits and policies Apply appropriate coding knowledge (CPT, ICD-10, HCPCS) to ensure correct claim processing Analyze claim documentation, including medical records, provider submissions, and billing statements Identify discrepancies, errors, or potential fraud/abuse and escalate as needed Process adjustments, denials, and reprocessing requests in accordance with guidelines Maintain productivity and quality standards while meeting turnaround time requirements Collaborate with internal teams (e.g., customer service, provider relations) to resolve claim issues Ensure compliance with HIPAA, regulatory requirements, and organizational policies

Qualifications:

3-5 years of experience in medical claims examination, adjudication, or processing Strong knowledge of healthcare claims workflows and medical terminology Familiarity with CPT, ICD-10, and HCPCS coding systems Experience working with health plans, TPAs, or managed care organizations preferred High attention to detail and analytical skills Strong communication and problem-solving abilities Proficiency with claims systems and Microsoft Office applications

Preferred Qualifications:

Experience with high-volume claims processing environments Exposure to Medicare, Medicaid, or commercial health plan claims Understanding of MSO or provider-side claims workflows is a plus

Work Environment:

Fast-paced, detail-driven environment requiring strong organizational skills and the ability to manage multiple priorities effectively. All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.