Claims Auditor
Shift: Day | Hours: 7:00 AM – 3:30 PM
Start Date: Immediate
Contract Length: 3 Months

Position Summary:
The Claims Auditor supports the Claims Department by auditing medical claims, ensuring accurate payments, regulatory compliance, and maintaining claims system integrity.

Key Responsibilities:
Review and audit medical claims for accuracy and compliance
Ensure claims are paid according to Medicare, Medi-Cal, and internal guidelines
Investigate and resolve overpayments, underpayments, and refunds
Prepare and generate audit and quality reports
Assist with staff training and serve as a resource for providers and internal teams
Support health plan audits and Provider Dispute Resolution claims

Required Qualifications:
High school diploma or equivalent
4+ years of medical claims processing experience
Knowledge of ICD-10, CPT, and RVS coding
Understanding of HMO/IPA operations
Strong organizational, communication, and time-management skills
Proficiency with claims systems and reports

Preferred:
Bilingual in Spanish or Chinese

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.