Talent.com
Claims Specialist

Claims Specialist

VanderHouwenWhittier, CA, US
3 hours ago
Job type
  • Full-time
Job description

SNAPSHOT

  • Contract for 13 weeks
  • On-site in Whittier, CA
  • Up to $28 an hour
  • Monday - Friday 7am - 4pm
  • Must have two years' healthcare claims experience

Claims Examiner

Our client is seeking a detail-oriented Claims Examiner to review, analyze, and process medical claims with a focus on accuracy and compliance. The ideal candidate will have hands-on experience with reimbursement methodologies, familiarity with Division of Financial Responsibility (DOFR), and a strong background in processing laboratory claims within managed care environments.

This role is onsite in Whittier California.

Claims Examiner Responsibilities

  • Review and adjudicate professional and facility claims (HCFA-1500 and UB-04) in accordance with contract terms, regulations, and organizational policies.
  • Apply reimbursement guidelines and payment methodologies for professional, hospital, and ancillary claims.
  • Evaluate provider contracts to ensure correct application of fee schedules and capitation arrangements.
  • Verify claim accuracy, timeliness, and compliance with applicable laws and payer requirements.
  • Identify non-contracted providers and coordinate Letters of Agreement when necessary.
  • Resolve claim discrepancies by researching supporting documentation and communicating with providers.
  • Maintain claim processing productivity and quality standards while meeting turnaround times.
  • Collaborate with internal departments to improve claims workflows and system efficiencies.
  • Perform data entry and utilize claims management systems to process and update claim records.
  • Claims Examiner Qualifications

  • Minimum of 2 years of claims adjudication experience within an HMO, IPA, or managed care organization.
  • Demonstrated claims reimbursement expertise, including experience with DOFR and laboratory claim processing.
  • Working knowledge of payment methodologies for professional, hospital, skilled nursing, and ancillary services.
  • Understanding of regulatory and compliance guidelines for commercial, Medi-Cal, and senior health plans.
  • Ability to interpret provider contracts and apply reimbursement terms accurately.
  • Proficiency in managed care or claims processing systems and basic office automation tools.
  • Strong attention to detail, analytical thinking, and organizational skills.
  • High school diploma or equivalent required.
  • Compensation : $23-$28 / hr. (DOE)

    VanderHouwen Contractors Enjoy Exceptional Benefit Perks!

    As an eligible contract employee with VanderHouwen, you'll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.

    Meet VanderHouwen

    What kind of recruiter do you see yourself working with? One who prioritizes your best interest, no matter what? VanderHouwen does, and we're in it for the long game! Our recruiters focus on YOU, building meaningful, long-term relationships while developing a deep understanding of companies' staffing needs and workplace cultures. This approach helps us find an ideal job match that aligns with your unique career aspirations and goals.

    VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career!

    VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.

    Create a job alert for this search

    Claim Specialist • Whittier, CA, US

    Related jobs
    • Promoted
    Claims Specialist

    Claims Specialist

    Ardmore Home Design IncHacienda Heights, CA, US
    Full-time
    Ardmore Home Design (AHD), founded in 2008, is a privately owned, fast-paced, founder-led entrepreneurial company where we value people with strong skills to make our products and processes better ...Show moreLast updated: 2 days ago
    Claims Specialist

    Claims Specialist

    The Law Offices of Daniel KimCosta Mesa, California, United States, 92626
    Full-time
    At DK Law, we don't just represent our clients.We stand with them, all the way.We're modern injury and accident attorneys who go all the way for every client, from every background.At the heart of ...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Claims Specialist (Whittier)

    Claims Specialist (Whittier)

    VanderHouwenWhittier, CA, US
    Part-time
    Must have two years' healthcare claims experience.Our client is seeking a detail-oriented Claims Examiner to review, analyze, and process medical claims with a focus on accuracy and compliance.The ...Show moreLast updated: 12 hours ago
    • Promoted
    Senior Claims Specialist, Professional Liability

    Senior Claims Specialist, Professional Liability

    SedgwickLong Beach, CA, US
    Full-time
    Senior Claims Specialist, Professional Liability.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are f...Show moreLast updated: 5 days ago
    • Promoted
    Claims Process Specialist

    Claims Process Specialist

    California FAIR Plan AssociationLos Angeles, CA, US
    Full-time
    The Claims Process Specialist is responsible for overseeing and managing the end-to-end claims process for homeowners and commercial property claims. The role involves designing, implementing, monit...Show moreLast updated: 19 days ago
    • Promoted
    Claims Specialist

    Claims Specialist

    Illumination FoundationSanta Ana, CA, US
    Full-time
    Every person deserves compassion, dignity, and the safety of a place to call home.Homelessness is the largest social and public health crisis in California. Illumination Health + Home is a growing n...Show moreLast updated: 19 days ago
    • Promoted
    Claims Specialist - Public Entities - Base Salary to 115k / year - Los Angeles, CA

    Claims Specialist - Public Entities - Base Salary to 115k / year - Los Angeles, CA

    AllSearch Professional StaffingLos Angeles, CA, US
    Full-time
    Claims Specialist - Public Entities - Base Salary to 115k / year - Los Angeles, CA.Our client, a company that provides cost effective coverage programs and risk management solutions to its members is...Show moreLast updated: 13 days ago
    • Promoted
    • New!
    Claims Specialist

    Claims Specialist

    VanderHouwenWhittier, CA, United States
    Full-time
    Must have two years' healthcare claims experience.Our client is seeking a detail-oriented Claims Examiner to review, analyze, and process medical claims with a focus on accuracy and compliance.The ...Show moreLast updated: 16 hours ago
    • Promoted
    Claims Specialist - Crop

    Claims Specialist - Crop

    QBE InsuranceIrvine, CA, US
    Full-time +1
    At QBE, we are always looking to connect with top talent for current vacancies as well as for future opportunities.It is our aim to continuously build a strong candidate pipeline across all our bu...Show moreLast updated: 30+ days ago
    • Promoted
    Senior Claims Specialist

    Senior Claims Specialist

    Great American Insurance GroupLos Angeles, CA, US
    Full-time +1
    Great American Insurance Group.Working for a leader in the insurance industry means opportunity for you.Great American Insurance Group's member companies are subsidiaries of American Financial Grou...Show moreLast updated: 21 days ago
    • Promoted
    • New!
    Sr. Claims Specialist - Financial Institutions

    Sr. Claims Specialist - Financial Institutions

    Axis CapitalLos Angeles, CA, United States
    Full-time
    This is your opportunity to join AXIS Capital - a trusted.We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders.We also ...Show moreLast updated: 4 hours ago
    • Promoted
    Claims Processing Specialist (Los Angeles)

    Claims Processing Specialist (Los Angeles)

    Ultimate StaffingLos Angeles, CA, US
    Part-time
    We're looking for a detail-oriented Medical Claims Examiner / Claims Specialist to support a reputable organization in El Monte Area. This is great opportunity to use your claims knowledge and analyti...Show moreLast updated: 1 day ago
    • Promoted
    CA Claims Specialist

    CA Claims Specialist

    CorVelRancho Cucamonga, CA, US
    Full-time
    The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, un...Show moreLast updated: 30+ days ago
    • Promoted
    CA Claims Specialist

    CA Claims Specialist

    CorVel Enterprise Claims, Inc.Rancho Cucamonga, CA, US
    Full-time
    The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outco...Show moreLast updated: 30+ days ago
    • Promoted
    Sr. Corporate Claims Specialist

    Sr. Corporate Claims Specialist

    Golden State FoodsIrvine, CA, US
    Full-time
    Golden State Foods is a distinguished leader in the foodservice industry, offering an extensive array of products and services to a diverse clientele. Rooted in the values of quality service and int...Show moreLast updated: 30+ days ago
    Claims Specialist

    Claims Specialist

    TCI TransportationCommerce, California, .US
    Full-time
    Quick Apply
    Since 1978, TCI Transportation has been dedicated to serving our clients in the only way we know how – with integrity, passion, and ingenuity. We’ve spent the past 4 decades expanding our locations ...Show moreLast updated: 6 days ago
    • Promoted
    Claims Specialist

    Claims Specialist

    Illumination Health + HomeSanta Ana, CA, US
    Full-time
    Every person deserves compassion, dignity, and the safety of a place to call home.Homelessness is the largest social and public health crisis in California. Illumination health + home is a growing n...Show moreLast updated: 13 days ago
    • Promoted
    Senior Liability Claims Specialist

    Senior Liability Claims Specialist

    CorVel Enterprise Claims, Inc.Rancho Cucamonga, CA, US
    Full-time
    The Senior Liability Claims Specialist manages within company best practices complex and non-complex Auto and General Liability claims. This role works within delegated authority to ensure best poss...Show moreLast updated: 30+ days ago
    • Promoted
    CA WC Senior Claims Specialist (SIP) 4850

    CA WC Senior Claims Specialist (SIP) 4850

    CorVelRancho Cucamonga, CA, US
    Full-time
    CA WC Senior Claims Specialist (SIP) 4850.Claims Specialist for our Southern California Team.Claims Specialist manages within company standards and best practices complex and problematic, high visi...Show moreLast updated: 12 days ago
    • Promoted
    Senior Liability Claims Specialist

    Senior Liability Claims Specialist

    CorVelRancho Cucamonga, CA, US
    Full-time
    Senior Liability Claims Specialist.CorVel is seeking a Senior Liability Claims Specialist.The Senior Liability Claims Specialist manages within company best practices complex and non-complex Auto a...Show moreLast updated: 30+ days ago