A trusted Third-Party Administrator (TPA) specializing in Health & Welfare benefits for union plans has two openings for Claims Examiners. With decades of experience supporting labor organizations, our client takes pride in delivering accurate, timely, and personalized claims administration. We're currently seeking a Claims Examiner with at least 2 years of Anthem Blue Cross claims management experience to join their team and contribute to their continued excellence in member service.

Position Overview:
As a Claims Examiner, you will be responsible for accurately reviewing, processing, and adjudicating medical and dental claims in accordance with plan documents, policies, and regulatory requirements. You’ll work closely with both providers and participants, ensuring claims are handled efficiently and accurately for union members and their families.

Key Responsibilities:

Review and process medical, dental, and vision claims based on plan documents and industry standards

Utilize experience with Anthem Blue Cross systems and procedures to evaluate claim eligibility and resolve discrepancies

Collaborate with internal departments (eligibility, customer service, audit) to resolve issues and maintain accuracy

Communicate with providers, participants, and union representatives to clarify claim details and coverage

Research and apply appropriate CPT, ICD-10, and HCPCS codes for adjudication

Assist in claim appeals and reprocessing as needed

Ensure HIPAA compliance and maintain confidentiality of health records and participant information

Qualifications:

Minimum 2 years of claims processing experience with Anthem Blue Cross or equivalent large medical carrier

Strong knowledge of health and welfare benefit plans, especially in a union environment

Familiarity with medical billing codes, modifiers, EOBs, and coordination of benefits

High attention to detail and ability to analyze and interpret plan documents

Excellent communication and organizational skills

Experience working in a TPA environment preferred

Proficiency with Microsoft Office and claims processing systems

For immediate consideration, apply today!

Equal Opportunity Employer / Disabled / Protected Veterans

The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.