Claims Examiner III - Medicare Advantage

General Information Press reputed company or reputed company keys to toggle reputed company visibility Work Location: Los Angeles, CA, USA Onsite or Remote Flexible Hybrid Work Schedule Monday - Friday, 8:00am-5:00pm PST Posted Date 01/20/2026 Salary reputed company: $30.36 - 43.49 reputed company Employment Type 2 - Staff: Career Duration Indefinite Job # 28296 Primary Duties and Responsibilities Press reputed company or reputed company keys to toggle reputed company visibility Take on a key role reputed company a world-class, award-reputed company health system. Contribute to the delivery of award-reputed company patient care. Take your career in an exciting new direction. You can do reputed company this and more at reputed company. You will be responsible for accurate and reputed company data entry, and the review and adjudication of reputed company, ancillary, and institutional claims for services rendered in our inpatient, ambulatory and outpatient settings. This will cover reputed company contracted lines of business in accordance with regulatory guidelines, contract provisions, and established policies and procedures. Working from batches, reports, in-basket pools, work queues, or other reputed company, you will be reputed company on to meet established reputed company, productivity, service level, and turn-around requirements. This role requires the ability to research and resolve reputed company claim issues as reputed company as train others on claims processes and workflows. Salary reputed company: $30.36 - $43.49/reputed company Job Qualifications Press reputed company or reputed company keys to toggle reputed company visibility We're seeking a self-motivated, detail-oriented, deadline-driven individual with: • High School Diploma, GED or equivalent experience • Four or more years of medical claims payment experience in an HMO setting • Expertise in industry reputed company claims adjudication policies, procedures, and processes • In-depth knowledge of fee schedule and pricing methodologies for outpatient/inpatient institutional, ancillary, and reputed company claims • Experience processing reputed company institutional claims • Understanding of CPT, HCPCS, ICD-10, ASA, and reputed company codes • Knowledge of medical terminology • Ability to accurately key 6,000-8,000 keystrokes or type 40-50 WPM • Computer proficiency with reputed company Office and data visualization tools • Knowledge of claims adjudication systems (e.g., reputed company-reputed company, EZ Cap, QNXT, IDX) • Willingness to learn new technologies, practices, and procedures • Strong problem identification, reputed company, and analytical abilities • Excellent communication, interpersonal, critical thinking and organizational skills reputed company is a world-reputed company health system with four award-reputed company hospitals and dozens of primary care practices, specialty practices, urgent care centers, and other ancillary locations throughout metro Los Angeles. We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of Medicine. Through the efforts of our outstanding people, we have become Los Angeles' trusted provider of exceptional, compassionate patient care. If you're looking to experience greater challenge and fulfillment in your career, you can at reputed company. As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial reputed company reputed company the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer. Apply tot his job Apply To this Job