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

ZC9JNzVnM0VFVktxN3N5Y2NoS3ArdkRZS1E9PQ==
  • 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

CleanOffice, Inc.

Concierge Area Manager Job at CleanOffice, Inc.

 ...dynamic division of CleanOffice Inc., a trusted leader in the DMV area for over 20 years. We specialize in delivering top-tier services...  ...Be part of Concierge Plus. The Concierge+ Assistant Regional Manager supports the Regional Manager in ensuring exceptional... 

Vector Talent Solutions

Scrum Master Job at Vector Talent Solutions

 ...Scrum Master-Bellevue PRIMARY FUNCTION: This role is responsible for guiding teams on standard Scrum and Agile practices to become self-organizing, facilitating the Teams Release Cycle, and communicating with key stakeholders and decision-makers. ESSENTIAL... 

Equity LifeStyle Properties, Inc.

Assistant Property Manager Job at Equity LifeStyle Properties, Inc.

 ...Overview We are seeking a dedicated and detail-oriented Assistant Property Manager to join our team. The ideal candidate will play a crucial role in supporting the property management operations, ensuring that our properties are well-maintained and that tenants receive... 

Fuse Technical Group

Warehouse Operations Associate Job at Fuse Technical Group

 ...The Warehouse Operations job is an entry level position in our audio-visual equipment warehouse...  ...oral communication skills Planning, time management, collaboration, and...  ...clients, and its employees. Job Type: Full-time Pay: $20.00 - $24.00 per hour... 

Insight Global

Financial Accounting Analyst Job at Insight Global

**This role is fully onsite Monday-Friday, 8-4** Required Skills & Experience Bachelors degree in Accounting 3+ years of experience in accounting and finance Experience with QuickBooks or QuickBooks Online Extensive experience with Microsoft Office applications...