Are you an experienced healthcare claims professional looking for a **remote position** with a company that values your skills and offers long-term growth potential? Our client, a leading healthcare organization, is seeking a **Claims Processor** with **strong experience in Medi-Cal and Medicare claims**—especially for **professional claims** submitted by specialists such as Cardiologists, Surgeons, and OB-GYNs.

What You’ll Do:

* Review and process **non-delegated provider claims** (professional and outpatient)
* Ensure claim accuracy and verify services against **Medicare/Medi-Cal fee schedules**
* Determine eligibility for payment or denial
* Handle **coordination of benefits (COB)**, denials, and service reductions
* Collaborate with internal teams to resolve claim issues and ensure timely processing

What We’re Looking For:

2+ years of hands-on experience in professional or institutional claims processing
Proven knowledge of **Medicare and Medi-Cal** guidelines, policies, and fee schedules
Strong understanding of CPT, ICD-9, and ICD-10 coding
Familiarity with capitated managed care
Proficiency in **Windows-based applications** and solid **data entry** skills
Highly organized, detail-oriented, and able to thrive in a remote setting

Why You’ll Love This Role:

* 100% **remote work** – enjoy work-life balance from anywhere in the U.S.
* Join a **mission-driven team** making a real impact in healthcare
* Competitive pay and potential for **long-term placement**
* Work independently while still being part of a **collaborative team environment**


Ready to take the next step in your claims career? Apply today and join a team that recognizes your expertise and values your contributions.**



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.