Claims Examiner

We Are Looking for a Claims Examiner!

Location: Remote (On-site training in Fresno, CA) - must live within a 60 mile radius of Fresno

Job Type: Full-Time Hours | Remote After Training

Department: Claims | Reports to: Claims Manager

Why You’ll Love Working With One of Our Top Healthcare Clients

Are you passionate about making a difference in healthcare? Do you thrive in a fast-paced, detail-oriented environment? We’re looking for a Claims Examiner who’s ready to grow their career, contribute to a collaborative team, and enjoy the flexibility of remote work. Our client believes in supporting our employees with the tools, training, and culture they need to succeed. After completing your initial training in their Fresno office, you’ll transition to a 100% remote role—with ongoing support and a team that’s got your back.

What You’ll Do

• As a Claims Examiner, you’ll play a key role in ensuring our members receive accurate and timely claim processing. You’ll:
• Review and process medical, dental, vision, and HIPD claims with precision and care.
• Analyze documentation, verify pricing, and confirm prior authorizations.
• Collaborate with internal teams to resolve claim issues and ensure compliance.
• Interpret plan documents to determine benefits and adjudicate claims accurately.
• Identify trends, flag potential compliance issues, and contribute to process improvements.

What We're Looking For

• High school diploma or equivalent.
• 1–3 years of experience in health claims processing (medical, dental, vision, subrogation, or accident).
• Familiarity with UB-04, HCFA 1500, ICD-10, CPT, and HCPCS codes.
• Strong attention to detail and problem-solving skills.
• Proficiency in Microsoft Office and 10-key by touch (40 WPM typing speed).
• Ability to adapt in a dynamic, fast-paced environment.
• Knowledge of ERISA guidelines is a plus!

Perks & Benefits

• 100% Remote Work after training
• On-site Training Support in Fresno, CA
• Collaborative, Team-Oriented Culture
• Make a Real Impact in the lives of members and providers

Your Future Starts Here

If you're ready to take the next step in your healthcare career and want to be part of a team that values quality, collaboration, and innovation—apply today!