Remote Claims Examiner

Job Title: Remote Medical Claims Examiner (Medi-Cal / Managed Care)
Location: Fully Remote (Must work Pacific Time hours)
Schedule: Flexible start time between 6:00 AM - 9:00 AM PST, Monday-Friday

Pay: $22-$25/hour (based on experience)
Employment Type: Full-Time | Benefits PTO | Remote Equipment Provided

Are you an experienced Claims Examiner looking to work from home with a supportive, well-established team? We are seeking a motivated and detail-oriented individual who thrives in a fast-paced, mission-driven environment.

• Review and adjudicate 100-150 medical claims per day in accordance with health plan contracts and regulatory requirements.

• Manually price claims and interpret complex contracts for Medi-Cal, Medicare, and commercial lines of business.

• Investigate provider inquiries and assist with claims research across departments.

• Ensure compliance with internal policies, provider agreements, and CMS/DHCS regulations.

• Collaborate on process improvement and assist with training new team members.

• Participate in meetings and contribute to a positive team culture.

Must-Have:

• 1 year of experience as a Claims Examiner using an automated claims adjudication system

• Strong experience with Medi-Cal, and familiarity with Medicare and commercial claims

• Knowledge of medical coding (ICD, CPT, HCPCS) and ability to identify missing codes

• Ability to independently research and apply contract terms to adjudicate claims

• Experience in managed care settings

• High school diploma or GED

Nice to Have:

• Experience adjudicating multiple client/provider claims

• Familiarity with provider contracts and fee schedules

• Strong communication and collaboration skills

• Fully Remote: Work from the comfort of your home (equipment provided!)

• Flexible Schedule: Choose your start time between 6-9 AM PST

• Growth Opportunities: Leaders have all worked their way up internally

• Positive Culture: Team-building activities, holiday contests, and a collaborative spirit

• Competitive Benefits & PTO

Start your next chapter with a company that values your experience and offers room to grow.
Apply today and bring your skills to a high-performing, compassionate team.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.