Claims Specialist (Whittier)

VanderHouwenWhittier, CA, United States

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SNAPSHOT

Contract for 13 weeks
On-site in Whittier, CA
Up to $28 an hour
Monday - Friday 7am - 4pm
Must have two years' healthcare claims experience

Claims Examiner

Our client is seeking a detail-oriented Claims Examiner to review, analyze, and process medical claims with a focus on accuracy and compliance. The ideal candidate will have hands-on experience with reimbursement methodologies, familiarity with Division of Financial Responsibility (DOFR), and a strong background in processing laboratory claims within managed care environments.

This role is onsite in Whittier California.

Claims Examiner Responsibilities

Review and adjudicate professional and facility claims (HCFA-1500 and UB-04) in accordance with contract terms, regulations, and organizational policies.

Apply reimbursement guidelines and payment methodologies for professional, hospital, and ancillary claims.

Evaluate provider contracts to ensure correct application of fee schedules and capitation arrangements.

Verify claim accuracy, timeliness, and compliance with applicable laws and payer requirements.

Identify non-contracted providers and coordinate Letters of Agreement when necessary.

Resolve claim discrepancies by researching supporting documentation and communicating with providers.

Maintain claim processing productivity and quality standards while meeting turnaround times.

Collaborate with internal departments to improve claims workflows and system efficiencies.

Perform data entry and utilize claims management systems to process and update claim records.

Claims Examiner Qualifications

Minimum of 2 years of claims adjudication experience within an HMO, IPA, or managed care organization.

Demonstrated claims reimbursement expertise, including experience with DOFR and laboratory claim processing.

Working knowledge of payment methodologies for professional, hospital, skilled nursing, and ancillary services.

Understanding of regulatory and compliance guidelines for commercial, Medi-Cal, and senior health plans.

Ability to interpret provider contracts and apply reimbursement terms accurately.

Proficiency in managed care or claims processing systems and basic office automation tools.

Strong attention to detail, analytical thinking, and organizational skills.

High school diploma or equivalent required.

Compensation : $23-$28 / hr. (DOE)

VanderHouwen Contractors Enjoy Exceptional Benefit Perks!

As an eligible contract employee with VanderHouwen, you'll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.

Meet VanderHouwen

What kind of recruiter do you see yourself working with? One who prioritizes your best interest, no matter what? VanderHouwen does, and we're in it for the long game! Our recruiters focus on YOU, building meaningful, long-term relationships while developing a deep understanding of companies' staffing needs and workplace cultures. This approach helps us find an ideal job match that aligns with your unique career aspirations and goals.

VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career!

VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.

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Claim Specialist • Whittier, CA, United States