Medical & Dental Claims Specialist

AppleOne Employment Services; Fremont (CA); On-site; USD 80,000 - 96,000; Full time

Job summary

AppleOne Employment Services is seeking a detail-oriented Claims Examiner in Fremont, CA to process medical and dental claims with accuracy. You will interpret benefit plans, verify eligibility, apply coding standards, and ensure compliant claim outcomes in a high-volume environment.

Ideal candidates have at least 2 years of current claims processing experience, strong math and data entry skills, and proficiency with Microsoft Office.

Qualifications

• Minimum 2 years current experience processing medical and dental claims online.
• Knowledge of HIPAA, CPT, ICD-10, and HCPCS coding.
• Strong math skills and data entry accuracy.
• Proficient in Word, Excel, and Outlook; ten-key by touch.

Responsibilities

• Process medical and dental claims accurately in online systems.
• Interpret plan documents, eligibility, and provider guidelines.
• Recalculate claims using benefit formulas and coefficients.
• Communicate with providers and participants by multiple channels.
• Maintain detailed documentation of calls and claim activity.
• Support auditors and team with research and reporting.

Skills

Medical claims processing

Dental claims processing

HIPAA compliance

Attention to detail

Analytical thinking

Team collaboration

Customer communication

Tools

Carrier claims systems

Anthem Blue Cross system

Job description

AppleOne Employment Services is seeking a detail-oriented Claims Examiner in Fremont, CA to process medical and dental claims with accuracy. You will interpret benefit plans, verify eligibility, apply coding standards, and ensure compliant claim outcomes in a high-volume environment.

Ideal candidates have at least 2 years of current claims processing experience, strong math and data entry skills, and proficiency with Microsoft Office.