Claims Examiner I: Medical Claims Specialist

WESTERN GROWERS GROUP; Fresno (CA); Sur place; USD 52 000 - 74 000; Plein temps

Résumé du poste

WESTERN GROWERS GROUP in Fresno, CA is seeking a Claims Examiner I to review and process medical, dental, and vision claims in compliance with state, federal, and health plan requirements. The role emphasizes accurate pricing, prior authorizations, and timely payment.

You will analyze patient records, contact providers for documentation, and resolve issues across departments while maintaining HIPAA security and data integrity.

Qualifications

• High school education or equivalent with 3–5 years of health claims experience.
• Knowledge of HIPAA and medical terminology.
• Strong data entry and MS Office skills.
• Familiarity with UB-04, HCFA 1500, ICD-10, CPT/HCPCS.

Responsabilités

• Adjudicate medical, dental, and vision claims per guidelines.
• Analyze records to determine benefits and prior authorization.
• Communicate with providers to obtain required documentation.
• Maintain HIPAA-compliant workstation and security practices.
• Ensure quality and timely claim processing and routing.

Connaissances

HIPAA compliance

Data entry 40 WPM

Microsoft Office

Medical terminology

Communication

Formation

High school diploma or equivalent

Outils

UB-04 forms

HCFA 1500

ICD-10

CPT/HCPCS

Description du poste

WESTERN GROWERS GROUP in Fresno, CA is seeking a Claims Examiner I to review and process medical, dental, and vision claims in compliance with state, federal, and health plan requirements. The role emphasizes accurate pricing, prior authorizations, and timely payment.

You will analyze patient records, contact providers for documentation, and resolve issues across departments while maintaining HIPAA security and data integrity.