Claims Examiner I

Claims Examiner I responsible for reviewing and processing medical and facility claims from contracting and non-contracting providers and subscribers for payment, applying contract benefits and policies, and performing claims auditing. Role includes identifying billing errors and potential fraudulent claims, obtaining eligibility verification, ensuring accurate manual calculation of benefits, routing complex claims for review, and maintaining productivity and quality per guidelines. Requires high school diploma or equivalent and at least one year of medical claims processing experience, with strong organizational skills and decision-making ability. This on-site role operates in Bakersfield, CA, within an HMO environment, with hourly pay and a defined pay range.