Claims Examiner

Job Title: Claims Examiner Location: Whittier, CA 90601 Duration: 13 weeks / 3+ Months Shift: Day Shift | Monday-Friday | 07:00 AM - 03:30 PMPosition 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. Must have physical proof on hand if background check is unable to verify your education background. 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

Created: 2026-04-02