Senior Claims Examiner

Senior Claims Examiner, FT Days at PIH Health

The Senior Claims Examiner administers health plan contracts by processing medical claims in an efficient, cost‑effective, and timely manner, meeting all required guidelines and performing necessary adjustments. Duties include handling third‑party liability requests, out‑of‑pocket maximum requests, EDI rejects, and other special projects.

PIH Health is a nonprofit regional healthcare network serving approximately 3 million residents in Los Angeles County, Orange County, and the San Gabriel Valley. The fully integrated network includes hospitals, outpatient medical offices, a multispecialty medical group, home health and hospice services, and a variety of specialty services.

• Computer and 10‑key skills by touch
• Knowledge of medical terminology, CPT/RBRVS/ICD‑9 codes
• Full understanding of HMO & capitation concepts and Medicare guidelines
• Excellent communication skills
• Ability to work independently and meet tight deadlines

• High school diploma or GED; relevant experience in lieu of education will be considered
• Minimum two (2) years medical claims processing experience

• N/A

• Address: 6557 Greenleaf Ave., 90601
• Salary: $21.00–$33.78 per hour
• Shift: Days
• Employment type:
  
  Full‑time
• Seniority level:
  Mid‑Senior level
• Job function:
  Finance and Sales
• Industries:
  Hospitals and Health Care