Healthcare Claims Adjudicator - Precision and Compliance

Lsmamso; San Bernardino (CA); Hybrid; USD 50,000 - 70,000; Full time

Job summary

A management services organization in California is seeking a Claims Examiner to review, analyze, and adjudicate medical claims. The ideal candidate will have at least two years of experience in healthcare claims, strong analytical skills, and knowledge of billing and coding standards. This role involves collaborating with various departments to ensure compliance and efficiency in processing claims, while maintaining high production and quality standards. The position may require occasional weekend work to meet deadlines.

Qualifications

• Minimum two years of healthcare claims processing experience.
• Working knowledge of medical billing/coding basics.
• Experience interpreting benefits and reimbursement rules.

Responsibilities

• Review, analyze, and adjudicate medical claims.
• Resolve pended claims, denials, and adjustments.
• Collaborate with departments for accurate claim processing.

Skills

Claims lifecycle knowledge

Analytical and problem-solving skills

Attention to detail

Effective communication

Knowledge of HIPAA transactions

Proficient with Microsoft Office

Education

High school diploma or equivalent

Tools

Claims systems

Google Workspace

Job description

A management services organization in California is seeking a Claims Examiner to review, analyze, and adjudicate medical claims. The ideal candidate will have at least two years of experience in healthcare claims, strong analytical skills, and knowledge of billing and coding standards. This role involves collaborating with various departments to ensure compliance and efficiency in processing claims, while maintaining high production and quality standards. The position may require occasional weekend work to meet deadlines.