Medical Claims Processor

Medical Claims Processor

Immediate need for a talented Medical Claims Processor. This is a 06+months contract opportunity with long-term potential and is located in Bakersfield, CA (Onsite).

Key Responsibilities:

• Receive, review, and process medical claims and bills to determine appropriate payment or denial.
• Examine claim records for completeness, accuracy, and required supporting documentation.
• Research claims and billing information to identify missing documents, discrepancies, and processing exceptions.
• Analyze claim data and apply applicable benefit criteria and payment guidelines to determine appropriate claim outcomes.
• Review claim information and make adjustments in accordance with established procedures.
• Investigate vendor and member questions, concerns, complaints, and claim-processing issues.
• Research payment discrepancies and help resolve outstanding claim questions.
• Obtain or verify additional documentation needed to support claim review and adjudication.
• Maintain accurate records of claims reviewed, adjustments made, research performed, and resolutions.
• Communicate clearly with relevant internal teams and external vendors to facilitate claim resolution.
• Follow established procedures for handling confidential healthcare and member information.
• Manage assigned work efficiently while maintaining accuracy, organization, and timely follow-up.

Key Requirements and Technology Experience:

• High School Diploma or equivalent.
• 2–3 years of experience in medical claims processing, claims adjudication, claims examination, medical billing, or a closely related healthcare administrative role.
• Practical experience reviewing medical claims, bills, or supporting documentation.
• Ability to research discrepancies and determine appropriate next steps for claim resolution.
• Familiarity with payment and denial processes and the application of benefit criteria or claim-processing guidelines.
• Strong attention to detail and analytical problem-solving skills.
• Effective written and verbal communication skills.
• Good organizational skills and the ability to manage multiple tasks.
• Ability to handle confidential healthcare and member information appropriately.
• Ability and willingness to work onsite in Bakersfield, CA, and participate in an onsite interview.
• Experience with health insurance claims or healthcare payer operations.
• Familiarity with claims management systems, billing platforms, or electronic claims-processing systems.
• Experience handling claim exceptions, payment discrepancies, documentation requests, and vendor or member inquiries.
• Experience working in a structured healthcare administrative or claims-processing environment.