Claims Examiner

Prime Healthcare; Victorville (CA); On-site; USD 32,000 - 38,000; Full time

Benefits offered by this job

Comprehensive benefits for eligible

Paid time off and holidays

Professional development opportunities

Supportive and collaborative work环境

Career growth opportunities

Job summary

Desert Valley Medical Group in Victorville, CA is seeking a Claims Examiner to review and adjudicate healthcare claims, applying policies and processing standards. This full-time weekday role offers stable work and the opportunity to contribute to accurate claim processing.

The ideal candidate has 2+ years of healthcare claims experience, strong attention to detail, and solid analytical abilities. Benefits and professional development are provided within the Prime Healthcare network.

Qualifications

• 2+ years healthcare claims experience.
• Strong attention to detail and analytical skills.
• Ability to interpret and apply policies and procedures.
• Strong organizational and problem-solving skills.

Responsibilities

• Review and adjudicate routine and non-routine healthcare claims.
• Evaluate claims for accuracy, completeness, and appropriate processing.
• Apply established claims policies, procedures, and standards.
• Research and resolve claim discrepancies.
• Meet established processing timelines and quality expectations.
• Maintain accurate claims documentation.

Skills

Attention to detail

Analytical skills

Policy interpretation

Organizational skills

Education

High School Diploma or GED

Job description

Overview

Claims Examiner

Schedule: Full-Time | WeekdaysDepartment: ClaimsLocation: Desert Valley Medical Group | Victorville, CACompensation:$23.00 - $27.25 per hour (based on experience and qualifications)

Build Your Career in Healthcare Claims

Bring your healthcare claims experience toDesert Valley Medical Group. As aClaims Examiner, you will review and adjudicate healthcare claims while applying established policies, procedures, and processing standards.This full-time weekday opportunity is ideal for an experienced claims professional with strong attention to detail, sound judgment, and a commitment to quality.

What You'll Do

• Review and adjudicate routine and non-routine healthcare claims.
• Evaluate claims for accuracy, completeness, and appropriate processing.
• Apply established claims policies, procedures, and standards.
• Research and resolve claim discrepancies.
• Meet established processing timelines and quality expectations.
• Maintain accurate claims documentation.

What You Bring

• Minimum of 2 years of healthcare claims experience.
• Strong attention to detail and analytical skills.
• Ability to interpret and apply policies and procedures.
• Strong organizational and problem-solving skills.

What We Offer

• Comprehensive benefits for eligible employees
• Paid time off and paid holidays
• Professional development opportunities
• Supportive and collaborative work environment
• Opportunities for career growth

Responsibilities

Claims Examiner processes routine and non-routine claims using established claim standards, and departmental policies and procedures. To accurately evaluate and adjudicate claims in a timely manner and according to set standards. �

Qualifications

Education and Work Experience

• 2-3 years relevant experience in health care claims and customer service.
• Knowledge of Medical Terminology, Medical Insurance, and must be computer literate.
• High School Diploma or GED preferred.

Pay Transparency

Desert Valley Medical Group offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $23.00 to $27.25. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights:https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice

Privacy Notice for California Applicants:https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf