Job Description
Job DescriptionHealthcare Claims Examiner
Location: Whittier, CA
Shift: Monday – Friday | 7:00 AM – 3:30 PM
Position Overview
We are seeking an experienced Claims Examiner with strong UB-92 and HCFA-1500 claims processing experience. The Claims Examiner will be responsible for reviewing, adjudicating, and processing professional and facility claims for HMO patients. This role reports directly to the Claims Manager and requires prior experience working in a healthcare or managed care environment.
Key Responsibilities
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Process and adjudicate UB-92 and HCFA-1500 claims for medical groups, hospitals, and ancillary providers.
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Ensure claims are paid accurately and in compliance with timeliness and payment guidelines.
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Interpret provider contracts and apply correct reimbursement terms.
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Identify and manage non-contracted providers for Letter of Agreement (LOA) consideration.
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Maintain accurate claim records and perform data entry within managed care systems.
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Collaborate with internal teams to resolve claim discrepancies or escalations.
Required Qualifications
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Education: High School Diploma or GED (must be verifiable).
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Experience: Minimum 2 years of claims adjudication experience in an ambulatory, hospital, HMO, or IPA environment.
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Hands-on experience with UB-92 and HCFA-1500 claims forms.
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Knowledge of payment methodologies for hospitals, skilled nursing facilities, and professional services.
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Understanding of compliance, Medi-Cal, and commercial claims processing standards.
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Strong computer and data entry skills with managed care systems.