Claims Examiner

Medical Claims Adjudication Specialist Duration: 3+ months contract Responsibilities: Review, adjudicate, and process medical claims for HMO patients Work closely with affiliated medical groups and hospitals Evaluate provider reimbursement terms and flag non-contracted providers Ensure claims are processed accurately and timely per policy guidelines Experience: 2+ years of experience in claims adjudication (HMO, IPA, or hospital environment) Skills: Claims reimbursement knowledge Experience working with DOFR (Division of Financial Responsibility) Hands-on experience processing lab claimsFamiliar with UB-92 and HCFA-1500 forms Understanding of provider contracts, Medi‑Cal, commercial, and senior plan claims Strong knowledge of timeliness, payment accuracy, and compliance standards Basic computer and data entry skills Education: High school diploma, GED, or higher US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. #J-18808-Ljbffr