Medical Claims Processor Job at AppleOne Employment Services, San Bernardino County, CA

N3hVSDI1c04yd1FLT3VDaWFqcEp5MjE2c2c9PQ==
  • AppleOne Employment Services
  • San Bernardino County, CA

Job Description

Are you an experienced healthcare claims professional looking for a **remote position** with a company that values your skills and offers long-term growth potential? Our client, a leading healthcare organization, is seeking a **Claims Processor** with **strong experience in Medi-Cal and Medicare claims**—especially for **professional claims** submitted by specialists such as Cardiologists, Surgeons, and OB-GYNs.

🧩 What You’ll Do:

* Review and process **non-delegated provider claims** (professional and outpatient)

* Ensure claim accuracy and verify services against **Medicare/Medi-Cal fee schedules**

* Determine eligibility for payment or denial

* Handle **coordination of benefits (COB)**, denials, and service reductions

* Collaborate with internal teams to resolve claim issues and ensure timely processing

✅ What We’re Looking For:

** Must live in Southern California***

* **2+ years** of hands-on experience in **professional or institutional claims processing**

* Proven knowledge of **Medicare and Medi-Cal** guidelines, policies, and fee schedules

* Strong understanding of **CPT**, **ICD-9**, and **ICD-10** coding

* Familiarity with **capitated managed care** (a plus!)

* Proficiency in **Windows-based applications** and solid **data entry** skills

* Highly organized, detail-oriented, and able to thrive in a remote setting

💻 Why You’ll Love This Role:

* 100% **remote work** – enjoy work-life balance from anywhere in the U.S.

* Join a **mission-driven team** making a real impact in healthcare

* Competitive pay and potential for **long-term placement**

* Work independently while still being part of a **collaborative team environment**

Job Tags

Remote job,

Similar Jobs

Elevance Health

Investigator Assistant Job at Elevance Health

**Investigator Assistant****Supports the Payment Integrity line of business****Hybrid 1:** This role requires associates to be in-office **1-2** days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life... 

Archdiocese of St. Louis

Middle School ELA Teacher Job at Archdiocese of St. Louis

 ...Job Summary A Catholic Elementary School Teacher is responsible for fostering a Christ-centered, academically excellent learning environment that nurtures the spiritual, intellectual, social, and emotional growth of each student. The teacher will integrate Catholic... 

Reverba Global

Patient Outreach Representative Job at Reverba Global

 ...support, meeting notetaking and coordination, etc.) Minimum Qualifications Fluent in English Fluent in Spanish, Korean or Japanese (a plus) HS Diploma B.A./B.S. in English, Journalism, Public Relations or related field, or the equivalent degree is required... 

Oracle

Software Engineer Job at Oracle

 ...leading provider of business software. With a presence in over 175 countries...  ...ll Do:**We are seeking elite engineers with the expertise and passion...  ...design and build innovative new systems from the ground up....  ...2025. (Start date for all new grad roles: Summer/Fall 2025)+ Are... 

Waste Management

CDL Truck Driver- Port-O-Let0 6000 New hire bonus - 2206299 Job at Waste Management

$6000.00 New Hire Bonus CDL Class A/B with Tanker Endorsement Required As an EEO/Affirmative Action Employer, all qualified...  ...necessary to perform the job. A. Education and Experience Education: None required. Experience: No prior work experience...