Claims Examiner

Tustin, CA 92780

Post Date: 04/18/2018 Job ID: 42495 Profession: Medical Administrative
Are you experienced in Medical Claims and looking to work for a successful healthcare company?! Apply Now!
This Company focuses on servicing their members, providers, and internal clients with the highest values.
Job Activities:
  • Accurately adjudicate as directed
  • Accurately work aging report daily and suspend claims with appropriate suspension codes if unable to pay/deny
  • Ability to review and understand the DOFR
  • Ability to read and understand provider contracts
  • Knowledge of medical terminology, ICD9/ICD10 and CPT codes
  • Understanding the Medicare and Medi-Cal Fee tables and payment schedules
  • Able to work in a fast-paces environment, flexibility to handle multiple priorities while maintain a high level of professionalism
  • Maintains historical records by scanning and filing documents
  • Researching missing documentation on claims
  • Reviewing multiple files
  • Contacting providers for inquiries
  • Processing claim data
  • Processing reports to insure accurate input


  • 3 years of claims adjudication
  • 3 years of data entry
  • 3-5 years of health plan experience
  • Experience with Microsoft Office suite of programs (Word, Excel, Access)

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