Healthcare Claims Examiners & Adjusters (REMOTE)

• Job Details

1. Posting Date: 03-28-25
2. Reference ID: 238404
3. Location: Woodland Hills, CA
4. Work Location: Remote
5. Discipline: Healthcare Insurance
6. Job Type: Direct Hire
7. Salary Expectations/ Pay Rate or Range: $22.00-$25.00 per hour, $41,600-$52,000 annual salary (based on experience & position)

• Job Description

1. Responsibilities/ Job Duties:

Claims Examiners/Adjustors

• The claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the IPAs.
• Researches, reviews and contacts provider services for problem claims and issues, as needed.
• Accurately review all incoming Provider claims to verify necessary information is available.
• Meets production standards of 100-150 claims as established by claims management
• Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.
• Work with MEDI-CAL (California Medicaid), Medicare and Commercial claims.

• Minimum Education and Experience Qualification Requirements:

Claims Examiners/Adjustors -

• 1+ year HEALTHCARE claims examining experience (truly examining, processing doesn't apply).
• Must be experienced adjudicating claims for MEDI-CAL (California Medicaid) Managed Care Services - hard requirement but can live anywhere!
• Must have worked in a managed care setting doing medical claims (healthplan or MSO) - workers comp, dental, etc doesn't work .
• To qualify for the adjuster position, must have more diverse experience working with (ambulance, ER, hospital, DME) claims.

Schedule/ Shift: Can start shift between 6am-9am and end shift 3pm-6pm

• Benefits:

• PTO (Paid Time Off): Based on employee tenure, ranges from 15-25 days off per year.

• Holiday Pay: Receive holiday pay for all federal holidays after completing 90th day of employment; 7 paid federal holidays, 3 additional floating holidays.

• Health Benefits / Dental / Vision: Great low-cost group rates for employees! 100% company group paid employee premiums for HMO plan.

• 401k: Competitive company match of the employee's salary.

• Life & Supplemental Insurance

• Employee Assistance Program (EAP)

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.