• Job Description

  Req#: 32560070612

  We are seeking a Medical Claims Examiner ready to expand on their established career to partner with our client to impact and support patients in need!

  Out-of-state applicants are welcome to apply, and must have Anthem Blue Cross Systems claims processing experience.

  If you seek in-depth training, a positive office culture & career expansion. Then we look forward to connecting with you!

  Bilingual training/ expertise: Spanish preferred

  Location: Fremont, CA (Onsite or remote depending on experience/location )

  Salary: $68,000 - $74,000 (experience contingent)

  Schedule: Full-Time,

  Position type: Direct Hire opportunity

  Overview:

  We are seeking a detail-oriented and professional Claims Examiner to join our client in Fremont, CA. This role offers a dynamic opportunity for experienced medical claims professionals to leverage their skills in a supportive, high-performing environment. Bilingual proficiency in Spanish is highly desirable.

  This is a full-time, onsite position with no remote or hybrid options available.

  Key Responsibilities:

  The Claims Examiner is responsible for accurately processing various medical insurance claims for both active and retired participants in accordance with plan benefits, department procedures, and applicable regulations.

  • Duties include, but are not limited to:
  • Review, interpret, and adjudicate claims in alignment with plan rules, eligibility, exclusions, and limitations.
  • Utilize knowledge of PPO provider guidelines, Medicare coordination, and supplemental benefits during claims review.
  • Engage in claims processing using online adjudication systems, including systems provided by current carriers (e.g., Anthem Blue Cross).
  • Accurately input and edit claim data using Microsoft Word, Excel, and Access.
  • Provide professional-level customer service and assist participants with benefit-related inquiries.
  • Maintain detailed records of communications, including call summaries and eligibility verifications.
  • Operate office equipment such as computers, ten-key calculators, scanners, and fax machines.
  • Attend staff meetings and training sessions as needed.
  • Support internal audits and contribute to department goals as assigned by management.

  Customer Service Component:

  When serving as a Customer Service Representative:

  • Respond to participant and provider inquiries regarding eligibility, plan benefits, and claim statuses.
  • Quote plan language accurately without providing interpretive advice.
  • Document interactions thoroughly in both written and electronic formats.

  Knowledge, Skills, and Abilities:

  • Minimum 2 years of recent experience processing medical and dental claims online.
  • Solid understanding of group benefit plans and claims processing procedures.
  • Familiarity with HIPAA, Health Care Reform regulations, medical terminology, and coding systems (CPT, ICD-9, ICD-10, HCPCS).
  • Strong analytical and critical thinking skills.
  • Proficiency in Microsoft Word, Excel, and Outlook.
  • Ten-key by touch and strong data entry accuracy.
  • Ability to perform complex mathematical calculations involving percentages and formulas.
  • Excellent written and verbal communication skills.
  • Detail-oriented and able to organize and manage time effectively.
  • Ability to work collaboratively within a team and adapt to evolving responsibilities.

  Physical & Mental Requirements:

  • Must be able to sit for extended periods and perform repetitive tasks.
  • Strong attention to detail and the ability to focus in a busy office setting.
  • Ability to meet productivity benchmarks while maintaining quality and accuracy.

  Testing Requirements:

  Applicants must complete the following assessments:

  • Written and verbal claims examiner evaluation
  • Online cognitive/reasoning and reading comprehension assessments
  • Microsoft Word, Excel, and Outlook proficiency tests

  Tags:

  #MedicalClaims #ClaimsExaminer #InsuranceJobs #HealthcareAdmin #ClaimsProcessing #OnsiteJob #FremontJobs #MedicalTerminology #BilingualJobs #PPO #HIPAA #HealthcareJobs

• About the company

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