Medical Claims Processor
2 weeks ago
Job Title : Claims Examiner Location: Whittier, CA
Start Date: January 19, 2026
Duration: 13 weeks
Schedule Shift: Monday–Friday | 7:00 AM – 3:30 PM (Day Shift)
5x8s-Hour, 40 hours/week
Pay Rate: $28/hour
Description :
PIH Health Physicians is seeking experienced Claims Examiners to support claims adjudication and payment processing for HMO patients. This role reports directly to the Claims Manager and requires hands-on experience with medical claims reimbursement.
EDUCATION/EXPERIENCE/TRAINING
Required :
Minimum 2 years of verified claims adjudication experience
Experience in ambulatory, acute care hospital, HMO, or IPA environments
Must have claims reimbursement experience
Must have DOFR
Must have processed laboratory claims
High school diploma or GED required (physical proof must be available)
Knowledge of managed care and office automation systems
Strong attention to detail and compliance standards
DUTIES AND RESPONSIBILITIES
Process, adjudicate, and pay UB-92 and HCFA-1500 medical claims
Review claims from affiliated medical groups and hospitals
Ensure compliance with timeliness and payment accuracy guidelines
Apply payment methodologies for:
Professional (MD) services
Hospital services
Skilled Nursing Facilities
Ancillary services
Interpret provider contract reimbursement terms
Identify non-contracted providers for potential Letters of Agreement
Maintain accurate data entry within managed care systems
Ensure compliance with commercial, senior, and Medi-Cal claim requirements
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