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Sr. Claims Examiner

Company: The Judge Group
Location: Orange
Posted on: September 21, 2022

Job Description:

Location: Orange, CA Description: Judge Healthcare is currently seeking a Sr. Claims Examiner to join our client's amazing and growing team in Orange, CA!This position is responsible for analyzing and validating claims elements and claims processing. The incumbent is responsible for adhering to the regulatory and internal guidelines in conjunction with company policies and procedures related to claims adjudication. Senior level examiner is responsible to adjudicate complex claims, requiring additional research or problem solving. This job will have the following responsibilities:

  • Processes both professional and institutional claims types. -
  • Performs thorough review of pending claims for billing errors and or questionable billing practices that mighty include duplicate billing and unbundling of services. -
  • Responsible for manually correcting system generated errors prior to final claims adjudication. -
  • Processes claims based upon contractual agreements or pricing agreements, applicable regulatory legislation, claims processing guidelines and policies and procedures. -
  • Analyzes, validates Medi-Cal pricing, researches, adjusts, and adjudicates claims, reviews services for accurate charges; utilizing billing code sets and/or authorization guidelines as reference. -
  • Processes claims based upon contractual and/or agreements, involving the use of established payment methodologies, Division of Financial Responsibility. -
  • Alerts manager or supervisor of more complex issues that arise. -
  • Processes claim exception reports as assigned. Qualifications & Requirements:
    • High School diploma or equivalent required. -
    • 3+ years of experience processing online claims in a managed care environment required.
    • Experience processing Medi-Cal and/or Medicare claims preferred.
    • ICD-10 Knowledge required
    • Knowledge of benefit interpretation and administration preferred. -
    • Knowledge of Medicare/Medi-Cal guidelines and regulations preferred. If you or someone you know is interested in this position, please send a current resume to Parker at pdornbier@judge.com for immediate consideration! Contact: This job and many more are available through The Judge Group. Find us on the web at

Keywords: The Judge Group, Orange , Sr. Claims Examiner, Other , Orange, California

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