We are seeking an experienced Claims Processor/Customer Service Representative with a strong background in medical and dental claims processing. A minimum of two years of current claims processing experience and experience working with Anthem Blue Cross systems is required. This role requires the ability to accurately interpret plan benefits, eligibility, limitations, and exclusions, while applying knowledge of PPO guidelines, coordination of benefits, Medicare, and supplemental plan benefits.

The ideal candidate will be proficient with claims coding, including CPT, ICD-9/10, and HCPCS, and must have familiarity with HIPAA regulations and Health Care Reform requirements. Daily responsibilities include processing claims, reconciling discrepancies, maintaining accurate documentation, and communicating with providers and participants by phone, email, and correspondence. Strong technical skills are essential, including data entry, ten-key by touch, and proficiency with Microsoft Office programs, along with the ability to quickly learn and navigate carrier systems—particularly Anthem Blue Cross.

This is an excellent opportunity for a detail-oriented, organized professional who can maintain high levels of accuracy while meeting production benchmarks and supporting both members and providers with professionalism and care

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.