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Claims Examiner

Job

E-Solutions IT Services Private Limited

Whittier, CA (In Person)

$60,320 Salary, Full-Time

Posted 3 weeks ago (Updated 2 weeks ago) • Actively hiring

Expires 7/18/2026

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Job Description

Claims Examiner E-Solutions IT Services Private Limited - 3.4 Whittier, CA Job Details Contract $28 - $30 an hour 22 hours ago Qualifications Regulatory compliance in claims processing High school diploma or GED Medical billing regulations compliance Healthcare compliance Full Job Description Overview We are seeking a dedicated Claims Examiner to join our dynamic team, responsible for thoroughly reviewing and processing claims related to workers' compensation cases. This role is essential in ensuring accurate adjudication, compliance with workers' compensation law, and prevention of fraudulent claims. The ideal candidate will possess strong analysis skills, organizational abilities, and a customer-focused approach to deliver exceptional service while maintaining the integrity of the claims process. This position offers an opportunity to contribute to a reputable organization committed to fair and efficient claims management. Responsibilities Process, adjudicate, and pay UB-92 and
HCFA-1500
claims received from affiliated medical groups and hospitals for HMO patients. Report directly to the Claims Manager. Identify non-contracted providers for Letter of Agreement consideration. Interpret provider contract reimbursement terms (desirable). Strong understanding of payment methodologies for Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services. Knowledge of compliance issues, timeliness, and payment accuracy guidelines for commercial, senior, and Medi-Cal claims. Data entry experience. Training and proficiency in basic office automation and managed care computer systems.
MUST HAVE
Education Verification:
Must be able to provide a copy/picture of a High School Diploma, GED, or higher education degree upon submission.
Claims Experience:
2+ years of dedicated Claims Processing and Reimbursement experience (must be explicitly detailed on your resume).
Adjudication Expertise:
Proven experience with the
ADJUDICATION
of UB-92 and
HCFA-1500
claims.
Specialized Healthcare Knowledge:
Direct, hands-on experience working with DOFR (Division of Financial Responsibility) provisions.
Claim Types:
Demonstrated experience processing laboratory claims.
Shift Timing :
7AM-3:30PM Weekly schedule: M-F CH1
Pay:
$28.00 - $30.00 per hour
Experience:
Claims Processing and Reimbursement :
2 years (Required)
License/Certification:
High School Diploma or GED (Required)
Work Location:
In person