PIH Health · 1 day ago
Senior Claims Examiner, FT Days
Whittier, CA
Full-time
Onsite
Mid, Senior Level
$21/hr - $33.78/hr
2+ years expPIH Health is a nonprofit, regional healthcare network serving approximately 3 million residents in the Los Angeles County area. The Senior Claims Examiner is responsible for administering health plan contracts by processing medical claims efficiently while meeting all required guidelines and performing necessary adjustments.
Health Care
Responsibilities
Administers health plan contracts by processing medical claims in an efficient, cost-effective, and timely manner meeting all required guidelines
Performs adjustments as necessary
Handling of Third-Party Liability requests
Out-of-pocket Maximum requests
EDI rejects and other special projects
Qualification
Required
Computer and 10-key skills by touch
Knowledge of medical terminology, CPT/RBRVS/ICD-9 codes
Full understanding of HMO & capitation concepts and Medicare guidelines
Excellent communication skills
Ability to work independently and function under time deadlines
High school diploma or General Education Development, relevant experience in lieu of education will be considered
Minimum two (2) years medical claims processing experience
Company
PIH Health
PIH Health is a nonprofit, regional healthcare network.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Charlotte A. Weaver
PIH Health, Vice Chair, Finance Committee, Audit Committee, Executive Committee
Recent News
2025-11-10
Company data provided by crunchbase