Claims Examiner
?? Fremont, CA (100% On-Site | BART Accessible)
?? Direct Hire | ?? Salary: $77,205.00

We are seeking an experienced Claims Examiner to join the team in Fremont, CA. This is a full-time, on-site position offering competitive pay, stability, and growth opportunities.

About the Role

As a Claims Examiner, you will be responsible for accurately processing medical and dental claims, interpreting plan benefits, and ensuring compliance with HIPAA and industry standards. The ideal candidate will have strong analytical skills, attention to detail, and the ability to communicate effectively with providers, participants, and internal teams.

Key Responsibilities

Process medical and dental claims with accuracy and efficiency.

Interpret plan benefits, eligibility, limitations, and exclusions.

Develop knowledge of PPO guidelines, coordination of benefits, Medicare, and supplemental plans.

Use Anthem Blue Cross and other carrier systems for online claims processing and data entry.

Provide customer service by answering eligibility and benefits questions directly from plan documents.

Communicate with providers and participants via phone, email, fax, and in person.

Assist auditors, managers, and support other departmental duties as assigned.

Requirements

Minimum 2 years of current medical and dental claims processing experience (not just billing and coding).

Knowledge of HIPAA regulations, health care reform requirements, medical terminology, CPT, ICD-9/10, and HCPCS codes.

Strong skills in claims recalculation and applying formulas (multiplication/percentages).

Proficiency in Microsoft Word, Excel, Outlook, and 10-key by touch.


Testing Requirements

All applicants must complete:

Written & verbal Claims Examiner test.

Timed online assessments (reasoning, comprehension, vocabulary).

Proficiency tests in Microsoft Word, Excel, and Outlook.

Apply today to bring your claims processing expertise to the dedicated team!

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.