Claims Examiner

Job Description

Job Description

Claims Examiner I / II

Location: Bakersfield, CA
Pay: $22-$23.10/hr
Schedule: Full-Time
Employment Type: Temp-to-Hire

Position Summary

Key Staffing is currently recruiting for a Claims Examiner I / II to join a growing healthcare organization in Bakersfield, CA. This position is responsible for reviewing, auditing, and processing medical and facility claims submitted by providers, subscribers, and members in an accurate and timely manner.

The ideal candidate will possess experience in medical claims processing, medical billing, coding, and healthcare insurance operations. This role requires strong analytical skills, attention to detail, and the ability to apply benefit plans, policies, and procedures while ensuring compliance with established guidelines.

This position may be filled at either the Claims Examiner I or Claims Examiner II level based on experience and qualifications.

Essential Duties & Responsibilities

• Review and process medical and facility claims accurately and efficiently.
• Resolve suspended claims related to:
• • Primary Care Providers (PCPs)
  • Laboratory services
  • Radiology services
  • Physical therapy services
  • Specialty providers
• Apply contract benefits, policies, and procedures to determine appropriate claim payment.
• Deny inappropriate claims in accordance with company guidelines.
• Identify billing errors and potential fraudulent claim submissions.
• Prepare and route claims requiring additional review to appropriate departments.
• Investigate eligibility and coordination of benefits (COB) information.
• Verify member eligibility and insurance coverage through online systems and other resources.
• Perform manual benefit calculations when necessary.
• Identify claims that may require additional investigation or review.
• Process and document overpayment refund requests.
• Maintain productivity and quality standards in accordance with departmental goals.
• Collaborate with supervisors and internal departments to resolve complex claims issues.
• Perform additional duties as assigned.

Qualifications Required

• High School Diploma or equivalent.
• Up to 1-2 years of medical claims processing, medical billing, or related healthcare experience.
• Experience investigating Coordination of Benefits (COB).
• Ability to calculate benefits and reimbursement amounts accurately.
• Strong attention to detail and problem-solving skills.
• Ability to work independently in a fast-paced environment.

Preferred

• Health Maintenance Organization (HMO) claims processing experience.
• Experience with Knox-Keene regulated healthcare plans.
• Knowledge of medical claims auditing and payment processes.

Knowledge, Skills & Abilities

• Medical terminology.
• HCPCS, CPT, and ICD-10 coding.
• UB-04 and CMS-1500 claim forms.
• Medical claims processing systems and online data entry platforms.
• Coordination of Benefits (COB) and subrogation investigations.
• Ability to communicate effectively with providers, staff, and stakeholders.
• Strong organizational and time management skills.
• Ability to adapt to changing priorities and work environments.

Why Apply?

• Opportunity to join a stable and growing healthcare organization.
• Professional development and career growth opportunities.
• Collaborative team environment.
• Meaningful work supporting healthcare operations and member services.

Commitment to Diversity: As an equal opportunity employer committed to meeting the

needs of a multi-generational and multicultural workforce, Key Staffing recognizes that a diverse

staff, reflective of our community, is an integral and welcome part of a successful and ethical

business. We hire local talent at all levels regardless of race, color, religion, age, national origin,

gender, gender identity, sexual orientation, or disability and actively foster inclusion in all forms

both within our company and across interactions with clients, candidates, and partners.