Claims Examiner

Northridge, CA 91201

Posted: 09/04/2018 Profession: Claims Job Number: 43705

Are you looking to join a well-established healthcare organization who puts an emphasis on quality patient care? Well this might be the right place for you!

Our client, a large healthcare organization, is in need of a Medical Claims Examiner/Claims Specialist to be hired on a full-time, permanent basis. The main responsibilities include determining insurance coverage, examining and resolving medical claims, documenting actions, maintaining quality customer service, and ensuring legal compliance.


  • Determines covered medical insurance losses by studying provisions of policy or certificate
  • Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims
  • Documents medical claims actions by completing forms, reports, logs, and records
  • Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter
  • Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations
  • Maintains quality customer services by following customer service practices; responding to customer inquiries


  • Experience in Medical Claims Processing (preferably working with HMO)
  • Strong understanding of Managed Care Healthcare environment
  • Excellent customer service skills
  • Demonstrated ability to meet or exceed production requirements

Why work here:

  • Full benefits package including medical, dental, life insurance, generous PTO, 401K
  • Opportunities for advancement in a stable, growing organization
  • Inclusive company culture, employee perks!

This is a direct-hire, permanent placement, full-time opportunity with benefits.

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