Claims Examiner
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AI Summary
Review and process medical claims by verifying member eligibility and applying coding standards to ensure accuracy. Coordinate with providers and internal departments to resolve discrepancies and maintain compliance with healthcare regulations.
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
About the Role:
MedPOINT Management in Sherman Oaks, CA is looking for a detail-oriented Claims Examiner to join our growing team. This is a great opportunity to play a key role in the healthcare management space, ensuring accurate and timely processing of medical claims. If you thrive in a fast-paced environment and have a passion for precision, we want to hear from you!
Responsibilities:
- 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
About Us:
MedPOINT Management is a leading Independent Physician Association (IPA) management company based in Sherman Oaks, CA, dedicated to delivering high-quality healthcare administrative services. Our clients trust us to manage their operations with integrity, efficiency, and a patient-first mindset. We foster a collaborative and supportive work environment where employees are empowered to grow and make a meaningful impact in the healthcare industry.
This is a remote position.
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