Claims Examiner

We’re a nonprofit, regional healthcare network with two hospitals, numerous outpatient medical offices, a multi-specialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer and emergency services. Our leadership is dedicated to putting patients first—a cornerstone of our mission, vision and values—as we deliver top-quality healthcare.

From our extensive facilities in Whittier, California and Downey, California, PIH Health serves more than two million residents in Los Angeles and Orange Counties and throughout the San Gabriel Valley.

The Claims Examiner reports directly to the Claims Manager.  He/she is primarily responsible for the processing functions (operation, adjudication, and payment); of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.

Required Skills

• 1. Self-motivated.
  2. Positive attitude.
  3. Excellent verbal and written skills.
  4. Ability to learn quickly.
  5. Possess strong computer skills.
  6. 10-key by touch, data entry experience preferred.
  7. Basic math competency.
  8. Deal effectively in a fast-paced, changing environment.
  9. Good organizational skills.
  10. Ability to work independently as well as be part of a team.
  11. Develops effective working relationships with all levels of the organization, including administration, doctors, and staff.
  12. Ability to identify and solve problems.

Required Experience

• High School graduate or G.E.D. is required
• Must have a minimum two (2) years of claims pricing and processing experience in ambulatory, acute care hospital, HMO or IPA environment.
• Must have knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
• Must have thorough understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims.
• Experienced in interpreting provider contract reimbursement terms strongly preferred

Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package.  We are an equal opportunity employer and seek diversity in our workforce.   EOE M/F/D/V