Review and process medical, dental, vision, and electronic claims in accordance with state, federal, and health plan regulatory requirements.
The Claims Examiner I will analyze health care claims, identify discrepancies, verify pricing, confirm prior authorizations, and process claims for payment. This role also supports resolution of issues from providers, customer service, member services, health plans, and other internal stakeholders.
This is a contract position based in Fresno, CA with initial onsite training for two weeks and then fully remote work.
Requirements & Qualifications
Must have a Medical Billing and/or Coding Certification.
- High school diploma or equivalent
- 1 to 3 years of experience as a Health Claims Examiner or comparable industry experience preferred
- Minimum 1 year of experience processing medical, dental, and vision claims, including subrogation and accident claims
- Ability to interpret plan documents or Summary Plan Descriptions for claim adjudication and benefit determination
- Basic knowledge of medical terminology
- Familiarity with UB-04 and HCFA 1500 forms, ICD-10, CPT, and HCPCS codes
- Strong verbal and written communication skills
- Proficient in 10-key data entry, 40 WPM typing, and Microsoft Office
- Ability to work under pressure and adapt to changing environments
- Working knowledge of ERISA claims processing and adjudication guidelines
- Strong problem-solving, analytical, and decision-making skills
Benefits & Perks
- Medical, dental, and vision coverage
- Critical illness, accident, and hospital insurance
- 401(k) retirement plan with pre-tax and Roth contributions
- Voluntary life insurance and AD&D
- Short- and long-term disability
- Health spending account (HSA)
- Transportation benefits
- Employee assistance program
- PTO, vacation, or sick leave
Location
Fresno, California, US
Employment Type
Contractor
Experience Level
Entry Level
Remote work allowed
Yes
Posted
4 weeks ago