Claims Examiner I/II - Temporary

Kern Family Health Care; Bakersfield (CA); Hybrid; USD 30,000 - 33,000; Full time

Job summary

Kern Health Systems is seeking a Claims Processing Specialist at the Buck Owens Office in Bakersfield, CA. This full-time temporary role handles reviewing and processing medical and facility claims to ensure accurate payments under Knox-Keene HMO guidelines and contracting requirements.

The ideal candidate has 1–2 years of medical claim payment or billing experience, knowledge of COB, and the ability to calculate usual and prevailing fees.

Qualifications

• High School Diploma or equivalent.
• 1–2 years medical claim payment or medical billing experience.
• Experience investigating COB.
• Ability to calculate usual and prevailing fees.
• HMO claims payment-processing experience is desirable.

Responsibilities

• Deny inappropriate claims following policy guidelines.
• Prepare claims for routing to other departments.
• Review difficult claims with supervision.
• Identify billing errors and potential fraudulent submissions.
• Obtain eligibility verification and other health insurance coverage.
• Calculate benefits manually when applicable.
• Identify CCS eligible claims for investigation.
• Report overpayment refund requests on SharePoint.
• Maintain productivity and quality per guidelines.
• Adhere to company policies and procedures.

Skills

Medical billing

Claims processing

COB investigation

Data entry

Education

High School Diploma

Tools

CPT & ICD-9 coding

CPT & ICD-10 coding

UB04 forms

CMS1500 forms

Job description

KHS Buck Owens Office, 2900 Buck Owens Blvd., Bakersfield, California, United States of America

Job Description

Posted Tuesday, September 1, 2026 at 10:00 AM

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

This is a full-time temporary position. If selected, onboarding will be completed through a staffing agency.
"This position may be filled at the I or II level based on experience and qualifications."
Hybrid/Remote

About us

Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

About the role

Under management direction, responsible for reviewing and processing all types of medical and facility claims from contracting and non-contracting providers and from subscribers and enrollees for payment in an accurate and timely manner. Responsible for applying correct contract benefits, policies and procedures.

This position is responsible for claims auditing and payment functions for a Knox-Keene licensed health maintenance organization (HMO).

Essential Duties and Responsibilities

Resolve system suspended claims for:
PCPs

Labs Radiology

Less complicated specialists Physical Therapy

• Deny inappropriate claims following policy guidelines.
• Prepare claims that must be routed to other departments for further review.
• Review difficult claims with guidance from Claims Supervisor.
• Responsible for identifying billing errors and possible fraudulent claims submissions.
• Obtain eligibility verification and other health insurance coverage by Internet or POS.
• Responsible for correct manual calculation of benefits when applicable.
• Responsible for identifying possible CCS eligible claims for further investigation.
• Report overpayment refund requests on SharePoint log
• Maintain productivity and quality in accordance with established guidelines.
• Perform other job-related duties as required.
• Adheres to all company policies and procedures relative to employment and job responsibilities.
  

Employment Standards

High School Diploma from an accredited school or equivalent. Up to (1-2) years of medical claim payment or medical billing processing experience. Experience investigating COB. Ability to calculate usual and prevailing fees. Health maintenance organization (HMO) claims payment-processing experience is highly desirable.

Education and experience

Computerized on-line data entry systems; organizational structure of medical claims processing; methods and procedures utilized in medical claims processing; medical terminology; CPT & ICD-9 coding; COB & subrogation investigation.

Adapt to a rapidly evolving work environment; work independently; communicate with a variety of personnel and providers.

Knowledge of

Computerized on-line data entry systems; organizational structure of medical claims processing; medical terminology; HCPCS, CPT & ICD-10 coding, UB04 and CMS1500 forms.

Pay Rate

• CEI-22.00/hr
• CEII-23.10/hr

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

KHS Buck Owens Office, 2900 Buck Owens Blvd., Bakersfield, California, United States of America