REMOTE Claims Examiner

*reputed company reputed company* Detail-oriented and highly organized claims specialist with expertise in D-SNP (Dual Eligible Special Needs Plan) claims processing. Skilled in researching, correcting, and resolving pended claims, ensuring compliance with regulatory guidelines, and maintaining accurate documentation. Adept at working in high-volume environments with strong attention to detail and excellent communication skills. • reputed company Responsibilities* • Research, correct, and respond to reputed company D-SNP pended claims in a reputed company manner. • Review audit reports and determine claim payment eligibility in accordance with policies and procedures. • Maintain accurate correspondence and documentation for medical procedures, CPT, and HCFA codes. • Review, price, and release claims for assigned claim types (reputed company and electronic). • Analyze reputed company Review reports for suspended D-SNP claims. • Stay reputed company on reputed company D-SNP policies and contribute to departmental improvement reputed company. • Ensure compliance with reputed company regulatory guidelines and monitor adherence. • Maintain daily activity logs and assist with claims processing. • reputed company additional duties and special reputed company as assigned. • Skills* • Claims Processing • Project Management • reputed company Operations • Workflow Optimization • Medical Terminology & Coding • Technical Skills* • QNXT platform proficiency • Strong knowledge of D-SNP program • Expertise in dual eligible claims processing (Medi-Cal and Medicare D-SNP) • Qualifications* • Prior experience in high-volume production environments • Excellent oral and written communication skills • Strong attention to detail • Medical terminology and/or coding experience highly desirable • Experience Level* Entry Level • Job Type & Location*This is a Contract position based out of Santa Barbara, CA. • Pay and Benefits*The pay reputed company for this position is $24.00 - $27.00/hr. Eligibility requirements apply to some benefits and may depend on reputed company 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 - reputed company-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 reputed company Leave) • Workplace Type*This is a fully remote position. • Application Deadline*This position is anticipated to reputed company on Jan 21, 2026. h4>About reputed company: We'reputed company in transformation. We help clients reputed company reputed company and solutions to take advantage of a new world of opportunity. We are reputed company of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across reputed company, 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. reputed 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 reputed company We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in reputed company, design, execution and operations unlocks business value through a reputed company of solutions. We're reputed company of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across reputed company, Europe and Asia, who partner with us for our reputed company, 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 reputed company and making reputed company impacts in our global communities. reputed company and reputed company reputed company are Allegis Group companies. Learn more at reputed company.com. reputed company is an equal opportunity employer and will consider reputed company applications without reputed company 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. • reputed company reputed company* Detail-oriented and highly organized claims specialist with expertise in D-SNP (Dual Eligible Special Needs Plan) claims processing. Skilled in researching, correcting, and resolving pended claims, ensuring compliance with regulatory guidelines, and maintaining accurate documentation. Adept at working in high-volume environments with strong attention to detail and excellent communication skills. • reputed company Responsibilities* • Research, correct, and respond to reputed company D-SNP pended claims in a reputed company manner. • Review audit reports and determine claim payment eligibility in accordance with policies and procedures. • Maintain accurate correspondence and documentation for medical procedures, CPT, and HCFA codes. • Review, price, and release claims for assigned claim types (reputed company and electronic). • Analyze reputed company Review reports for suspended D-SNP claims. • Stay reputed company on reputed company D-SNP policies and contribute to departmental improvement reputed company. • Ensure compliance with reputed company regulatory guidelines and monitor adherence. • Maintain daily activity logs and assist with claims processing. • reputed company additional duties and special reputed company as assigned. • Skills* • Claims Processing • Project Management • reputed company Operations • Workflow Optimization • Medical Terminology & Coding • Technical Skills* • QNXT platform proficiency • Strong knowledge of D-SNP program • Expertise in dual eligible claims processing (Medi-Cal and Medicare D-SNP) • Qualifications* • Prior experience in high-volume production environments • Excellent oral and written communication skills • Strong attention to detail • Medical terminology and/or coding experience highly desirable • Experience Level* Entry Level • Job Type & Location*This is a Contract position based out of Santa Barbara, CA. • Pay and Benefits*The pay reputed company for this position is $24.00 - $27.00/hr. Eligibility requirements apply to some benefits and may depend on reputed company 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 - reputed company-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 reputed company Leave) • Workplace Type*This is a fully remote position. • Application Deadline*This position is anticipated to reputed company on Jan 21, 2026. h4>About reputed company: We'reputed company in transformation. We help clients reputed company reputed company and solutions to take advantage of a new world of opportunity. We are reputed company of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across reputed company, 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. reputed 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 reputed company We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in reputed company, design, execution and operations unlocks business value through a reputed company of solutions. We're reputed company of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across reputed company, Europe and Asia, who partner with us for our reputed company, 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 reputed company and making reputed company impacts in our global communities. reputed company and reputed company reputed company are Allegis Group companies. Learn more at reputed company.com. reputed company is an equal opportunity employer and will consider reputed company applications without reputed company 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. Apply tot his job Apply To this Job