Remote Claims Examiner - Healthcare Adjudication Specialist

MedPOINT Management; Los Angeles (CA); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

401(k)

401(k) matching

Dental insurance

Health insurance

Vision insurance

Wellness resources

Company parties

Employee discounts

Free food & snacks

Opportunity for advancement

Paid time off

Parental leave

Savings bank

Training & development

Job summary

MedPOINT Management in Sherman Oaks, CA is seeking a detail-oriented Claims Examiner to join our growing team. This role focuses on accurate and timely processing of medical claims within a healthcare management context.

You will review claims, verify eligibility, apply coding standards (ICD-10, CPT, HCPCS), resolve discrepancies, and coordinate with providers and members while maintaining HIPAA compliance and precise record-keeping.

Qualifications

• 2+ years of experience in medical claims processing or claims examination.
• Proficiency in ICD-10, CPT, and HCPCS coding.
• Familiarity with HMO, PPO, and managed care plan structures.
• Strong knowledge of EOB and claims adjudication processes.
• Experience with claims management software and healthcare information systems.
• Excellent attention to detail and strong analytical skills.
• Effective written and verbal communication skills.
• Knowledge of HIPAA regulations and healthcare compliance standards.

Responsibilities

• Review, analyze, and process medical claims in accordance with plan benefits and company guidelines.
• Verify member eligibility, provider information, and coverage details prior to claims adjudication.
• Identify and resolve claims discrepancies, duplicates, and billing errors.
• Apply ICD-10, CPT, and HCPCS coding knowledge to ensure accurate claims processing.
• Coordinate with providers, members, and internal departments to resolve claims inquiries.
• Maintain accurate records and documentation in claims management systems.
• Ensure compliance with state and federal healthcare regulations, including HIPAA.

Skills

Attention to detail

Analytical skills

Written and verbal communication

Tools

ICD-10 coding

CPT coding

HCPCS coding

Claims management software

Job description

MedPOINT Management in Sherman Oaks, CA is seeking a detail-oriented Claims Examiner to join our growing team. This role focuses on accurate and timely processing of medical claims within a healthcare management context.

You will review claims, verify eligibility, apply coding standards (ICD-10, CPT, HCPCS), resolve discrepancies, and coordinate with providers and members while maintaining HIPAA compliance and precise record-keeping.