Job Summary
We are seeking an experienced Claims Examiner for a full-time, temp-to-hire opportunity in Bossier City, LA. This role is ideal for a detail-oriented insurance claims professional with experience reviewing, analyzing, and adjudicating medical, dental, and short-term disability claims.
The Claims Examiner will work in a professional insurance environment where accuracy, compliance, and timely service are essential. This opportunity offers the chance to join a supportive team with strong leadership, clear expectations, and a collaborative culture focused on quality, accountability, and continued professional growth. Candidates who enjoy problem-solving, interpreting benefits, working with healthcare documentation, and helping resolve claim issues will be well suited for this position.
Key Responsibilities
- Review, analyze, and process medical, dental, and short-term disability claims for accuracy, eligibility, coverage, and benefit levels.
- Evaluate claim documentation, medical information, coding, and plan provisions to determine payment eligibility, medical necessity, adjustments, or denials.
- Process secondary claims and apply coordination of benefits requirements to determine primary or secondary payer responsibility.
- Communicate with providers, patients, and group representatives to obtain missing information, clarify documentation, and support timely claim resolution.
- Document claim activity, decisions, correspondence, adjustments, appeals, and issue resolution details within the claims management system.
- Ensure claims are processed in compliance with HIPAA, regulatory requirements, company policies, productivity standards, and a minimum accuracy target of 95%.
Compensation and Benefits
- Pay range: $13.00 to $15.00 per hour.
- Job type: Temp-to-hire.
- Schedule: Full-time.
- Benefits: Competitive pay plus benefits.
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.
Required Qualifications and Skills
- Review and adjudicate medical, dental, and short-term disability claims.
- Interpret plan documents, benefit provisions, eligibility rules, and coverage guidelines.
- Apply coding, medical terminology, coordination of benefits, and documentation standards during claim review.
- Research, adjust, document, and resolve claim issues, appeals, and benefit questions.
- High school diploma or equivalent required.
- Minimum of 2 years of medical, dental, disability, or healthcare claims processing experience required.
- 3 to 5 years of related claims review or claims adjusting experience preferred based on role level.
- Working knowledge of ICD-10 diagnosis codes, CPT procedure codes, HCPCS coding, medical terminology, and dental terminology.
- Experience determining claim eligibility, medical necessity, benefit levels, denials, and adjustments.
- Knowledge of coordination of benefits processes for primary and secondary payer claims.
- Proficiency with Microsoft Office Suite and computer-based claims systems.
- Strong analytical, problem-solving, and decision-making skills.
- Exceptional attention to detail with a commitment to accuracy, quality, and compliance.
- Ability to manage multiple priorities independently in a fast-paced claims processing environment.
- Excellent written, verbal, and customer service communication skills.
Preferred Qualifications
- Associate’s or Bachelor’s degree preferred.
- Experience with LuminX or EBIX claims adjudication software preferred.
- Previous Third-Party Administrator experience strongly preferred.
- Experience adjudicating medical, dental, and short-term disability claims.
- Knowledge of healthcare benefits administration and insurance regulations.
- Familiarity with appeals, claim adjustments, eligibility verification, and claim research.
- Ability to interpret complex plan documents, policy provisions, and benefit guidelines accurately.
Please send your resume to sfuentes@appleone.com Thank you!