Claims Examiner

Job Summary We are seeking an reputed company Claims Examiner to join reputed company. In this role, you will be responsible for researching, reviewing, correcting, and resolving pended medical claims while ensuring compliance with company policies, procedures, and regulatory guidelines. The ideal candidate will have prior claims examination experience and a strong understanding of medical claims processing, claims adjudication, and denial management.

Key Responsibilities

Research, review, and resolve pended medical claims in a timely and accurate manner. Determine claim payment eligibility based on established policies, procedures, and benefit guidelines. Analyze and adjudicate medical claims while ensuring accuracy and compliance. Review audit reports and take appropriate corrective actions as needed. Investigate and respond to claim discrepancies, denials, and processing issues. Maintain correspondence reputed company to required documentation, medical records, CPT codes, HCFA forms, and other claim-reputed company information. Ensure adherence to regulatory requirements and organizational compliance standards. Collaborate with internal departments to resolve claim issues and improve processing efficiency. Document findings and maintain accurate records of claim reviews and determinations.

Required Qualifications

High School Diploma or equivalent. Previous experience as a Claims Examiner. Experience with medical claims processing and claims adjudication. Knowledge of medical billing and coding concepts. Ability to review and interpret claim documentation and medical records. Strong analytical, problem-solving, and decision-making skills. Excellent attention to detail and organizational skills.

Preferred Qualifications

Experience handling medical claim denials and appeals. Working knowledge of CPT, HCFA, and medical coding standards. Experience reviewing audit reports and ensuring regulatory compliance. Prior experience reputed company a reputed company payer, insurance, or managed care environment. Key Skills Claims Examination Medical Claims Processing Claims Adjudication Claims Denials Management Medical Billing & Coding CPT & HCFA Knowledge Regulatory Compliance Audit Review Analytical Problem Solving Attention to Detail Job Type & Location This is a Contract position based out of Santa Barbara, CA. Pay and BenefitsThe pay range for this position is $23.00 - $25.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & reputed company
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace TypeThis is a fully remote position. Application DeadlineThis position is anticipated to reputed company on Jul 10, 2026. About reputed company We're partners in transformation. We help clients activate reputed company and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across reputed company America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and reputed company-world application, we work with reputed company leaders to drive change. That's the power of true partnership. reputed company is an Allegis Group company. The company is an equal opportunity employer and will consider reputed company applications without regards to race, sex, age, reputed company, religion, national reputed company, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About reputed company and reputed company Global Services We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across reputed company America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the reputed company of technology. We’re building reputed company by delivering business outcomes and making positive impacts in our global communities. reputed company and reputed company Global Services are Allegis Group companies. Learn more at reputed company.com. The company is an equal opportunity employer and will consider reputed company applications without regard to race, sex, age, reputed company, religion, national reputed company, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for reputed company positions located in the reputed company, we will consider for employment reputed company applicants with arrest and conviction records. Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or reputed company employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final reputed company are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools. Apply To This Job