Claims Examiner II

Monterey Park, CA 91754

Employment Type: Direct Job Category: Claims Job Number: 56083

Job Description

We have an opening for an experience Claims Examiner to join a national Managed Services Organization (MSO), and ensure timely and accurate processing of medical claims. Through this MSO, you will be providing quality claims support to clients, such as medical groups and Independent Physician Groups (IPAs).

We are seeking a Claims Examiner to process and adjudicate CMS-1500 claim forms including Primary Care and Pediatric claims. The ideal candidate will take pride at being a problem-solver and detail-oriented. If you are a goal-setter and work effectively and within timelines, you re a great fit. And you must have the ability to multitask in a fast-paced work environment.

Become a part of our organization! You will have the opportunity to be a strong team player and join a growing MSO.

In this role, you will:

  • Correspond and interview with medical specialists, agents, witnesses, or claimants to compile information
  • Take accurate and detailed statements from all involved parties
  • Calculate and approve payment of claims within a certain monetary limit
  • Comply with claims deadlines: Commercial 45 days; Medi-Cal 30 days, Medicare 30 non-contracted days and Medicare contracted 60 days.
  • Identify and report any underpayment overpayment.

For this job, you need:

  • Previous experience in medical CMS-1500 claims process and adjudication
  • Be knowledgeable of ICD-9, ICD-10, CPT, and HCPC codes
  • Know Federal and State requirements in claims processing
  • Strong negotiation skills
  • Excellent written and verbal communication skills
  • Deadline and detail-oriented

Why you want to work here:

You will have the opportunity to work with a team of physicians whose goals are to provide infrastructure and technology to healthcare practices to ensure efficiency and profitability. The organization is rapidly-growing and current has more than 300 employees. This provides you with room for growth and opportunities for advancement.


  • Insurance benefits including medical, dental, vision & PPO
  • are offered 100% for employee. Employee pays for dependents
  • Employer offers paid time off (PTO) of 12 days, plus 3 bonus days and also 401k match.

Apply to Medical Professionals today to learn more about this exciting opportunity.

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