The Claims Examiner is responsible for reviewing, analyzing, and processing medical claims while ensuring compliance with plan benefits and healthcare regulations. They must also coordinate with providers and members to resolve inquiries and maintain accurate documentation in management systems.
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.
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