Claims Examiner

Overview United Staffing Associates is conducting a temporary staffing search on behalf of a respected nonprofit health care organization serving hundreds of thousands of Californians through a managed care health plan. This organization is recognized for its mission-driven culture, commitment to improving community health, and collaborative work environment. We are seeking an experienced Claims Examiner I / II to join their Claims Department. This is an excellent opportunity for candidates with health plan (payer-side) medical claims processing experience who enjoy detailed analytical work and making an impact behind the scenes of patient care. Employment and onboarding will be completed through United Staffing Associates. This is a full-time temporary assignment - 6 months, 8am - 5pm Responsibilities Review and process medical and facility claims for payment Apply contract terms, benefit plans, and claims policies accurately Resolve suspended and exception claims Investigate Coordination of Benefits (COB) issues and eligibility Identify billing errors, overpayments, and potential fraudulent claims Calculate benefits and reimbursements when manual review is required Route complex claims for additional review when appropriate Maintain established productivity and quality standards Collaborate with internal teams to ensure timely claim resolution Qualifications Required High school diploma or equivalent 1-2 years of medical claims payment processing or medical billing experience Experience processing claims on the payer/HMO health plan side Working knowledge of medical terminology Experience with HCPCS, CPT, ICD-10 coding, CMS-1500, and UB-04 claim forms Experience investigating Coordination of Benefits (COB) Strong attention to detail and analytical skills Ability to work independently in a fast-paced environment Preferred Experience with a Knox-Keene licensed Health Maintenance Organization (HMO) Experience identifying billing discrepancies, overpayments, or potential fraud Knowledge of CCS eligibility review Compensation Claims Examiner I: $22.00/hour Claims Examiner II: $23.10/hour Placement at the I or II level will depend on experience and qualifications. Why Apply? This opportunity offers the chance to apply your payer-side claims expertise in a collaborative, fast-paced environment while supporting efficient claims processing and high-quality healthcare operations. If you\'re looking for a temporary opportunity to leverage your experience in medical claims administration, we\'d love to hear from you. #J-18808-Ljbffr United Staffing Associates