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Robert Half Medical Claims Examiner in Encino, California


A Healthcare Organization in the Mid-Wilshire area is in need of a Medical Claims Examiner on a temporary to full-time basis. Looking for someone with at least 2+ years of medical claims experience, has strong medical terminology and knowledge of CPT Codes and ICD 10.

Main day to day duties:

-Accurate and timely processing of delegated claims per regulatory and contractual guidelines

-Review policy booklet and guidelines to determine coverage of claims under the policy

-Research and respond to scheduled reports regarding claim inquiries

-Provide benefits to providers, participants and their business managers.

-Investigate and adjudicate complex claim requests

-Write follow-up letters to participants and providers to request additional information if needed.

This role is remote but the candidate must live near Encino CA to attend in office training.


Medical Claims

Medical Terminology

HMO, PPO and Managed Care

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