Job ID: 1807237
Reference Code: VI-Medical-Payers Side Claims 1yr exp
Are you an experienced payer-side Medical Claims Examiner looking for your next opportunity? We are seeking detail-oriented professionals with hands-on health plan, HMO, insurance carrier, or third-party administrator (TPA) claims processing experience. Review and process medical and facility claims accurately and efficiently
Important: Candidates must have recent **payer-side medical claims adjudication experience. Provider office, medical billing, AR, collections, or customer service experience alone will not meet the requirements for this position.
Join a team where your claims expertise, attention to detail, and healthcare knowledge make a direct impact.
Qualifications
Required Experience
Minimum 1 year of payer-side medical claims processing or claims examiner experience
Experience adjudicating medical and facility claims for a health plan, HMO, insurance carrier, or TPA
High School Diploma or equivalent
Required Knowledge
Medical terminology
CPT, HCPCS, and ICD-10 coding
CMS-1500 and UB-04 claim forms
Eligibility verification processes
Benefits and claims adjudication guidelines
Healthcare claims policies and procedures
Computer Skills
Experience with computerized claims processing systems
Strong data entry and system navigation skills
Microsoft Outlook, Word, and Excel proficiency preferred
Ability to work across multiple systems while maintaining accuracy
Required Skills
Strong analytical and problem-solving abilities
Excellent organizational skills
High attention to detail
Ability to work independently in a fast-paced environment
Strong written and verbal communication skills Please note: Payer-side claims adjudication experience is a mandatory requirement. Applicants without direct health plan, insurance carrier, HMO, or TPA claims processing experience will not be considered.
Adjudicate claims according to established benefit plans and guidelines
Resolve suspended and exception claims
Research eligibility and coverage information
Identify billing discrepancies and potential claim issues
Process claim denials following policy requirements
Calculate benefits and payment amounts when needed
Escalate complex claims for additional review
Maintain productivity and quality standards
Document claim activity and processing outcomes
Collaborate with internal departments to support claim resolution
Ensure compliance with healthcare regulations and company policies As the busy healthcare season approaches, we're seeking professionals who thrive in a high-volume environment and enjoy using their expertise to solve problems and deliver accurate results.
Equal Opportunity Employer / Disabled / Protected Veterans
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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.
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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.