Claims Examiner
Location: Whittier
Posted on: June 23, 2025
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Job Description:
POSITION SUMMARY: The claims examiner reports directly to the
claims manager. They are primarily responsible for the processing
functions (operation, adjudication, and payment) of UB-92 and
HCFA-1500 claims that are received from PHP affiliated medical
groups and hospitals for HMO patients.
EDUCATION/EXPERIENCE/TRAINING: • High school graduate or equivalent
required • Minimum of 2 years claims ADJUDICATION related
experience in ambulatory, acute care hospital, HMO, or IPA
environment • Knowledge of payment methodologies for: Professional
(MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
* Knowledge and understanding of timeliness and payment accuracy
guidelines for commercial, senior and Medi-Cal claims * Knowledge
of compliance issues as they relate to claims processing •
Experience in interpreting provider contract reimbursement terms
desirable • Ability to identify non-contracted providers for Letter
of Agreement consideration • Data entry experience • Training on
basic office automation and managed care computer systems.
Keywords: , Covina , Claims Examiner, Administration, Clerical , Whittier, California
