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

UTZoR3phTDgwa2lnL1VWSWdBM0s1SGZDWHc9PQ==
  • 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

TMT

Sales Development Rep (SDR) Job at TMT

 ...makers? We're seeking a dynamic Sales Development Representative (SDR) to join our team and help us drive growth. At TMT, we pride...  ...-of-the-funnel lead generation for account executives and sales managers. Respond to inbound interests and proactively reach out to targeted... 

Cactus Communications

Medical Director Job at Cactus Communications

 ...standards, and implementing best practices. Work with clients Medical Affairs and Medical...  ..., paternity, and sabbaticals. Healthcare: Comprehensive medical, dental, and vision...  ...New Jersey, with teams in Switzerland, the United Kingdom, India, and Japan, we help... 

Ground Up Careers

Senior Construction Project Manager Job at Ground Up Careers

 ...The Senior Project Manager is the highest-level project manager responsible for overall direction of the largest revenue projects for the...  ..., maintain liaison with prime client contracts, and monitor construction and financial activities through on-site PMs or construction... 

WheelHouse IT

IT Support Agent Job at WheelHouse IT

 ...skills Clear written and verbal communication Capable of working a standard M-F work week (and very occasional nights/weekends)...  ...provided on-site, employees may have the opportunity to work from home. If you are a student or recent graduate who is passionate about... 

Equity LifeStyle Properties, Inc.

Assistant Property Manager Job at Equity LifeStyle Properties, Inc.

 ...What youll do: The Assistant Property Manager provides exceptional customer service to attract and serve our guests and ensure we meet our financial goals. The Assistant Property Manager will work alongside the Resort Manager operating out of Grey's Point located in...