Our client, is a dedicated Health & Wellness Third-Party Administrator providing benefit and claims solutions for employers and their members. Our clients mission is to ensure an exceptional service experience through accuracy, integrity, and compassionate support. They are expanding their team and seeking an experienced Claims Examiner who is detail-oriented, committed to compliance, and passionate about delivering high-quality member service.

Position Overview
The Claims Examiner will be responsible for reviewing, processing, and adjudicating healthcare claims in accordance with plan benefits, regulatory guidelines, and internal policies. The ideal candidate has strong analytical skills, understands medical terminology and claims processing systems, and thrives in a collaborative team environment.

Key Responsibilities
Review, analyze, and process medical, dental, and/or wellness claims
Apply plan rules, provider contracts, and benefit guidelines correctly
Investigate claim discrepancies and verify member eligibility & coverage
Ensure accuracy, timeliness, and compliance with HIPAA and regulatory requirements
Respond to inquiries from providers, members, and internal teams
Prepare documentation for appeals and claims adjustments
Maintain production and quality standards

Qualifications
2+ years of claims processing or TPA experience (health insurance required)
Knowledge of CPT, ICD-10, HCPCS codes, and medical terminology
Familiarity with ERISA, HIPAA, and claims compliance standards
Experience working with benefits administration or claims systems
Strong analytical and problem-solving skills
Excellent attention to detail and ability to meet deadlines
Strong written and verbal communication skills

Perks & Benefits
Competitive pay
Medical, dental, vision & wellness benefits
Paid time off & paid holidays
Career development & industry-specific training
Supportive, mission-driven team culture

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.