Claims Examiner

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $20 - $25 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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MedPOINT Management

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1988

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

MedPOINT Management is a California-based healthcare management services organization that supports independent practice associations (IPAs), provider networks, hospitals and contracted health plans with clinical quality, care management, administrative operations and technology solutions. For more than 32 years MPM has provided services including provider network operations, case management, utilization management, claims operations, credentialing, HEDIS/STARs quality measurement and analytics (via Cozeva), call center and financial management, and digital provider portals and resource libraries. The company emphasizes data security and compliance (SOC 2 and HITRUST e1 certifications for its EZ-CAP and Provider Web Portals) and focuses on enabling value-based care, quality improvement, and operational support for providers and payers.

📋 Description

• Review, analyze, and process medical claims in accordance with plan benefits and company guidelines • Verify member eligibility, provider information, and coverage details prior to claims adjudication • Identify and resolve claims discrepancies, duplicates, and billing errors • Apply ICD-10, CPT, and HCPCS coding knowledge to ensure accurate claims processing • Coordinate with providers, members, and internal departments to resolve claims inquiries • Maintain accurate records and documentation in claims management systems • Ensure compliance with state and federal healthcare regulations, including HIPAA

🎯 Requirements

• 2+ years of experience in medical claims processing or claims examination • Proficiency in ICD-10, CPT, and HCPCS coding • Familiarity with HMO, PPO, and managed care plan structures • Strong knowledge of EOB (Explanation of Benefits) and claims adjudication processes • Experience with claims management software and healthcare information systems • Excellent attention to detail and strong analytical skills • Effective written and verbal communication skills • Knowledge of HIPAA regulations and healthcare compliance standards • Legal authorization to work in the US

🏖️ Benefits

• 401(k) • 401(k) matching • Dental insurance • Health insurance • Vision insurance • Wellness resources • Company parties • Employee discounts • Free food & snacks • Opportunity for advancement • Paid time off • Parental leave • Savings bank • Training & development