Job Details

Job Title : Claims Examiner

Location: Whittier, CA

Start Date: January 19, 2026

Duration: 13 weeks

Schedule Shift: Monday–Friday | 7:00 AM – 3:30 PM (Day Shift)

5x8s-Hour, 40 hours/week

Pay Rate: $28/hour

Description

PIH Health Physicians is seeking experienced Claims Examiners to support claims adjudication and payment processing for HMO patients. This role reports directly to the Claims Manager and requires hands-on experience with medical claims reimbursement.

EDUCATION/EXPERIENCE/TRAINING

Required

• Minimum 2 years of verified claims adjudication experience
• Experience in ambulatory, acute care hospital, HMO, or IPA environments
• Must have claims reimbursement experience
• Must have DOFR
• Must have processed laboratory claims
• High school diploma or GED required (physical proof must be available)
• Knowledge of managed care and office automation systems
• Strong attention to detail and compliance standards

DUTIES AND RESPONSIBILITIES

• Process, adjudicate, and pay UB-92 and HCFA-1500 medical claims
• Review claims from affiliated medical groups and hospitals
• Ensure compliance with timeliness and payment accuracy guidelines
• Apply payment methodologies for:
• Professional (MD) services
• Hospital services
• Skilled Nursing Facilities
• Ancillary services
• Interpret provider contract reimbursement terms
• Identify non-contracted providers for potential Letters of Agreement
• Maintain accurate data entry within managed care systems
• Ensure compliance with commercial, senior, and Medi-Cal claim requirements