Top 180 Claims examiner i Jobs in California

CLAIMS EXAMINER I MSO
NORTH EAST MEDICAL SERVICES —Burlingame, CA
- $38 an hour
- Full-time
- HIPAA
- Mid-level
- Analysis skills
- Health insurance
- Dental insurance
Catastrophe Property Claims Examiner III (Remote)
California FAIR Plan Association —Los Angeles, CA
- $90,000 - $100,000 a year
- Full-time
- Remote
- Microsoft Word
- Management
- Mid-level
Quick Apply
Claims Examiner II
Partnership HealthPlan of California —Fairfield, CA
- $31.45 - $37.74 an hour
- Research
- Mid-level
- Office
Claims Examiner Trainee
Berkshire Hathaway Homestate Companies —Walnut Creek, CA
- Hybrid work
- Spanish
- Writing skills
- Basic math
- Paid holidays
- Health insurance
Quick Apply
Catastrophe Property Claims Examiner II (Remote)
California FAIR Plan Association —Los Angeles, CA
- $80,000 - $90,000 a year
- Full-time
- Remote
- Microsoft Word
- Management
- Mid-level
Quick Apply
Claims Examiner
City of Compton, CA —Compton, CA
- $79,747.80 - $93,499.20 a year
- Full-time
- Anatomy knowledge
- Management
- Writing skills
- Paid holidays
- Disability insurance
Claims Examiner I
WESTERN GROWERS GROUP —Fresno, CA
- $40,580.28 - $52,756.02 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Dental insurance
- Vision insurance
Quick Apply
3rd Party Claims Adjuster/Examiner - HYBRID
DB Insurance Co., Ltd. —Anaheim, CA
- $65,000 - $100,000 a year
- Full-time
- Hybrid work
- Google Workspace
- Mid-level
- Office
- Paid holidays
- Health insurance
CLAIMS EXAMINER II
NORTH EAST MEDICAL SERVICES —Burlingame, CA
- $36.92 - $41.85 an hour
- Full-time
- HIPAA
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Associate Bond Claims Examiner
Tokio Marine HCC —Los Angeles, CA
- $29.44 - $40.46 an hour
- Full-time
- Hybrid work
- Customer service
- Writing skills
- Office
Senior Claim Examiner I
AmTrust Financial Services, Inc. —Irvine, CA
- $49 - $54 an hour
- Full-time
- Mid-level
- 3 years
- Bachelor's degree
- Health insurance
- Dental insurance
Attorney – Insurance Litigation and Defense
Sunset National Insurance Company —Culver City, CA
- $150,000 - $200,000 a year
- Email
- Writing skills
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Quick Apply
2d
Claims Examiner III
Champion Health Plan is a Medicare Advantage Prescription Drug HMO C-SNP serving Medicare beneficiaries with End-Stage Renal Disease. —Long Beach, CA
- From $29 an hour
- Full-time
- Hybrid work
- Customer service
- Writing skills
- Office
- Health insurance
- Dental insurance
Quick Apply
Examiner Physician Assistant
Loyal Source Government Services —Rancho Mirage, CA
- $159,265 - $189,265 a year
- Monday to Friday
- Microsoft Word
- Microsoft Outlook
- Military
Quick Apply
Examiner Physician Assistant
Loyal Source Government Services —Rocklin, CA
- $64.69 an hour
- Monday to Friday
- Microsoft Word
- Microsoft Outlook
- Military
Quick Apply
Workers' Compensation Claims Examiner
JT2 Integrated Resources —California
- From $90,000 a year
- Full-time
- Mid-level
- 3 years
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
EXPERIENCED Medical Biller
BRIDGE MEDICAL —San Ramon, CA
- $25 - $40 an hour
- Full-time
- Private practice
- HIPAA
- 11+ years
- Health insurance
Quick Apply
Medical Claims Examiner
Insperity —Chatsworth, CA
- $24 - $30 an hour
- Hybrid work
- Mid-level
- Analysis skills
- Fair chance
- Disability insurance
- Health insurance
Safety & Training Manager
Confidential —Los Angeles, CA
- $90,000 - $110,000 a year
- Full-time
- CDL B
- Microsoft Word
- Classroom
- Relocation assistance
- Health insurance
Quick Apply
Safety Manager
Keolis North America —Pomona, CA
- $85,000 - $100,000 a year
- Full-time
- CDL B
- Microsoft Word
- Background check
- Health insurance
- Dental insurance
Quick Apply
10d

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claims examiner i jobs near california

CLAIMS EXAMINER I MSO

NORTH EAST MEDICAL SERVICES -
Burlingame, CA

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Job Details

Full-time
$38 an hour

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance

Qualifications

Customer communication
Quality data entry

Full Job Description

The Claims Examiner is responsible for the daily review, audit, examination, investigation and adjudication of professional claims. Must exceed qualitative standard and meet quantitative production standard. Assist Claims Supervisor with health plan delegation oversight audits, MSO management reports, and other special projects as needed.

ESSENTIAL JOB FUNCTIONS:

Perform the daily examination, auditing and adjudication activities to submitted professional claims based on established utilization criteria, Medi-Cal and/or Medicare guidelines, member’s Evidence of Benefit, and policies and procedures outlined in the MSO Claims Manual.
Must meet quantitative production standard of 750 claims per week.
Provides feedback on testing system upgrades and enhancements.
Responsible for the daily review of simple pre-payment claims reports. Identify processing errors and make corrections prior to the weekly FFS payment cycle.
Identify NEMS in-house billing errors and communicate with MSO Claims Supervisor and NEMS Billing Manager for correction.
Identify claims payment errors and/or system configuration flaws during day-to-day operation, report to department manager/supervisor and MSO System Configuration team to correct/resolve them.
Respond to first-level provider inquiries related to claims adjudication, denial and payment status and handle member billed issues when arise.
Assist in all pre and post audit activities for health plan’s delegation oversight audits.
Performs other job duties as required by manager/supervisor and NEMS Management Team.

Completion of a 2-year degree from an accredited University, may be substituted with relevant work experience in healthcare medical claims processing and examination field.
Two years’ experience in health insurance claims processing, examination, and adjudication preferred.
Excellent data entry skills required.
Working knowledge of managed care and/or healthcare claim reimbursement or medical billing in Medi-Cal and Medicare Advantage program preferred.
Working knowledge of State/Federal healthcare compliance requirements (HIPAA, AB1455, and ICE standards), particularly DHCS/Medi-Cal and/or CMS/Medicare guidelines preferred.
Working knowledge of medical terminology, standard code sets, and claim forms preferred.
Strong English communication skills with strong analytical and problem-solving skills.
Ability to self-manage in a detail-oriented environment.
Ability to operate PC based software programs or automated database management systems preferred.
Good organization and prioritization skills, outstanding in time management.

LANGUAGE:

Must be able to fluently speak, read and write English.
Fluent in other languages are an asset.

STATUS:

This is an FLSA NON-exempt position.
This is not an OSHA high-risk position.
This is a Full Time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

Apply Now

Refine Your Search

claims examiner i jobs in california

CLAIMS EXAMINER I MSO

Catastrophe Property Claims Examiner III (Remote)

Claims Examiner II

Claims Examiner Trainee

Catastrophe Property Claims Examiner II (Remote)

Claims Examiner

Claims Examiner I

3rd Party Claims Adjuster/Examiner - HYBRID

CLAIMS EXAMINER II

Associate Bond Claims Examiner

Senior Claim Examiner I

Attorney – Insurance Litigation and Defense

Claims Examiner III

Examiner Physician Assistant

Examiner Physician Assistant

Workers' Compensation Claims Examiner

EXPERIENCED Medical Biller

Medical Claims Examiner

Safety & Training Manager

Safety Manager

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