Claims Examiner
Career AdvocatesLos Angeles, California, United States
Posted December 11, 2025
Full Time
About the Company
Career Advocates delivers expert temporary and permanent staffing solutions, pairing skilled candidates with the right roles to drive organizational success. Their seasoned recruiters focus on understanding both client needs and candidate strengths, ensuring a precise match for every placement. The firm emphasizes thorough vetting and personalized service, which consistently results in high placement satisfaction. By combining industry expertise with a commitment to successful outcomes, Career Advocates stands out as a trusted partner for businesses seeking reliable talent.
Job Description
The Claims Examiner will research and resolve pending claims, review claim denials, and ensure timely processing in compliance with policies, procedures, and regulatory guidelines.
Requirements
- Review, price, and release paper and electronic claims for assigned claim types.
- Analyze Manual Review and Master Denial reports for all company health programs.
- Audit claims from specialized reports (e.g., ER, Family Planning, Mental Health).
- Identify and propose process improvements or automation in collaboration with the Supervisor.
- Contribute ideas for System Change Forms (SCFs) as needed.
- Stay updated on company health policies and support departmental improvement initiatives.
- Ensure compliance with all regulatory guidelines.
- Maintain a daily activity log.
- Assist in claims processing and report billing/error trends identified during reviews.
- Adhere to AB1455 Claims Settlement Practices and DHCS Regulations timelines.
- Perform additional duties and projects as assigned.
