Claims Examiner

Company: Pacer Group
Location: Whittier
Posted on: January 21, 2026

Job Description:

Job Description Job Title : Claims Examiner Location: Whittier, CA Start Date: January 19, 2026 Duration: 13 weeks Schedule Shift: Monday–Friday | 7:00 AM – 3:30 PM (Day Shift) 5x8s-Hour, 40 hours/week Pay Rate: $28/hour Description : PIH Health Physicians is seeking experienced Claims Examiners to support claims adjudication and payment processing for HMO patients. This role reports directly to the Claims Manager and requires hands-on experience with medical claims reimbursement. EDUCATION/EXPERIENCE/TRAINING Required : Minimum 2 years of verified claims adjudication experience Experience in ambulatory, acute care hospital, HMO, or IPA environments Must have claims reimbursement experience Must have DOFR Must have processed laboratory claims High school diploma or GED required (physical proof must be available) Knowledge of managed care and office automation systems Strong attention to detail and compliance standards DUTIES AND RESPONSIBILITIES Process, adjudicate, and pay UB-92 and HCFA-1500 medical claims Review claims from affiliated medical groups and hospitals Ensure compliance with timeliness and payment accuracy guidelines Apply payment methodologies for: Professional (MD) services Hospital services Skilled Nursing Facilities Ancillary services Interpret provider contract reimbursement terms Identify non-contracted providers for potential Letters of Agreement Maintain accurate data entry within managed care systems Ensure compliance with commercial, senior, and Medi-Cal claim requirements

Keywords: Pacer Group, Covina , Claims Examiner, Administration, Clerical , Whittier, California