Overview We are seeking a highly skilled and detail-oriented Medical Claims Examiner to join our healthcare administration team. The primary responsibility of this role is to review, process, and adjudicate medical insurance claims to ensure accurate and timely reimbursement for healthcare providers and patients. The ideal candidate will possess a comprehensive understanding of medical billing, coding, and insurance claim processing, with a focus on maintaining compliance with industry standards and guidelines. This position offers an opportunity to contribute to efficient revenue cycle management while supporting the delivery of quality healthcare services. Duties 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:

dedicated

Claims Processing and Reimbursement :

2 years (Required)

Work Location:

In person