Medical Claims Examiner

Medical Claims ExaminerJoin a team where your attention to detail and commitment to quality care make a difference. Thrifty Management Services, the dedicated MSO for Preferred IPA of California, seeks a skilled and compassionate Medical Claims Examiner to help us deliver exceptional healthcare support. In this role, you will be responsible for the accurate and timely adjudication of CMS 1500 and UB-04 claims, ensuring compliance with Medicare and Medi-Cal guidelines. At Thrifty, we pride ourselves on our people-first culture that values teamwork, compassion, and work-life balance. If you're passionate about improving healthcare, we'd love to meet you.Best-in-Class Benefits and Culture:We value our employees' time and efforts. Our commitment to your success is enhanced by competitive compensation of $20-$25 per hour, depending on experience, and an extensive benefits package including:Comprehensive health coverage: Medical, dental, and vision insurance providedRobust retirement planning: 401(k) plan available with employer matchingFinancial security: Life and disability insurance for added protectionFlexible financial options: Health savings and flexible spending accounts offeredWell-being and work-life balance: Paid time off, flexible schedule, and remote work choices providedPlus, we work to maintain the best environment for our employees, where people can learn and grow with the company. We strive to provide a collaborative, creative environment where everyone feels encouraged to contribute to our processes, decisions, planning, and culture.To thrive as the Medical Claims Examiner, you should have:Minimum of 2 years of medical claims payment experience in an HMO environment (i.e., MSO, IPA, or health plan)Solid knowledge of Medicare and Medi-Cal managed care claims processing and compliance guidelines.Experience with CPT-4, ICD-10-CM, RBRVS, ASA, and HCPCS, as well as an in-depth understanding of Medicare and Medi-Cal guidelines that apply to COB and Medicare Secondary Payer.Extensive familiarity and experience in planning benefit and co-payment determination, division of financial responsibility determination, claims policies and procedures, adjudication processes, and claim review and analysis involving NCCI rules.Extensive working knowledge of reimbursement methodologies for professional claims, including injectable drugs.Step into a pivotal role where your precision powers patient care! Thrifty Management Services is searching for passionate Claims Examiners who thrive on accuracy, efficiency, and impact. This is your moment if you're driven to ensure timely and accurate claims processing while supporting a people-first mission. Apply now and help us transform lives—one claim at a time!We are an equal opportunity employer that welcomes and encourages diversity in the workplace. We do not discriminate based on race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.Qualified applicants with arrest or conviction records will be considered for employment with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.