An employer in the Irvine area is seeking a Claims Examiner II. This is a hybrid position, working 2 days on site. The training for this role will be conducted on site 5x/week for the first few weeks. Contract to hire position. This individual will be responsible for the investigation, determination, and reporting of claims processing through auditing billing processes, including pre and post-billing activity. The Examiner will audit, conduct root cause analysis, identify issues and propose solutions to correct and prevent recurrence. They will assist management with implementation of measures to ensure claim processing and payment accuracy. They will also help monitor and review appeals processing of assigned accounts. This individual must have strong analytical skills as they will help run the formulas and find errors to determine the issues within the system, as well as how to best correct the issue.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to
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4 - 6 years of recent medical insurance/healthcare billing experience; including following responsibilities: deductibles, copayments, coinsurance, out of pocket maximums, out of network deductibles and exclusions, with strong understanding of medical terminology.
Previous experience as a medical claims examiner or auditor preferred.
Experience with claim investigation, quality assurance process, ad-hoc audits, claim reviews, claim auditing management, claim process improvement, and claim appeals; knowledge of claim settlement policies, and EOB interpretation.
Experience working with excel
In the job experience of EHR systems and medical insurance claims management softwares
Knowledge of state, federal, and applicable regulations pertaining to EHR and HIPAA.
Expertise with medical billing software or systems, and interacting with third party vendors.
Must have analytical experience (individual will be pulling claims and will go through a lot of manual auditing to find errors, review, edit and submit to billing.
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.