We’re seeking a Medical Claims Examiner with strong payor medical claims experience specifically within a Utilization Management Environment. The ideal candidate has hands on experience reviewing, analyzing, and processing claims as a payor, not just provider-side.
Responsibilities:
Review and process medical claims with a high degree of accuracy and attention to detail
Apply benefits, policies, and regulatory guidelines to adjudicate claims correctly
Identify discrepancies, potential errors, or inconsistencies and escalate when appropriate
Requirements:
High school diploma
Must have payor-side claims processing experience
(provider-only experience will not meet the requirement)
Strong claims background with understanding of benefits application and claim auditing processes

Apply for this great position as a medical claims examiner today! Contact Yarely Villalpando yvillalpando(@)appleone.com

Equal Opportunity Employer / Disabled / Protected Veterans

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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.

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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.