Claims Examiner I: Medical & Dental Adjudication

Western Growers; Fresno (CA); Presencial; USD 52.000 - 68.000; Jornada completa

Descripción de la vacante

Western Growers in Fresno, CA seeks a Claims Examiner I to review and process medical, dental, vision, and electronic claims per state, federal, and plan requirements, matching guidelines and quality targets. Will analyze documentation, verify pricing, and confirm prior authorizations to ensure timely payment.

The role collaborates with providers, customer service, member services, and health plan teams; requires HIPAA compliant work, accurate data entry, and adherence to ERISA guidelines.

Formación

• High school education or equivalent; 3–5 years in health claims preferred.
• Ability to interpret plan documents and SPDs for accurate adjudication.
• Strong written and verbal communication skills; detail-oriented.
• Proficient data entry (40 WPM) and Microsoft Office familiarity.
• Able to work under pressure and adapt to a changing environment.

Responsabilidades

• Adjudicate medical, dental, vision, and electronic claims per guidelines.
• Verify pricing, prior authorizations, and coordination of benefits as needed.
• Review and research health care claims for discrepancies and payment processing.
• Contact providers to obtain necessary documentation when required.
• Maintain HIPAA-compliant workstation and protect confidential data.
• Meet and maintain productivity and quality standards.

Conocimientos

Communication skills

Typing speed 40 WPM

MS Office proficiency

Educación

High school diploma or equivalent

Herramientas

MS Office

Descripción del empleo

Western Growers in Fresno, CA seeks a Claims Examiner I to review and process medical, dental, vision, and electronic claims per state, federal, and plan requirements, matching guidelines and quality targets. Will analyze documentation, verify pricing, and confirm prior authorizations to ensure timely payment.

The role collaborates with providers, customer service, member services, and health plan teams; requires HIPAA compliant work, accurate data entry, and adherence to ERISA guidelines.