Claims Examiner I

AltaMed Health Services is dedicated to providing exceptional care to the community. The Claims Examiner is responsible for analyzing and adjudicating medical claims, resolving payment issues, and collaborating with departments to address claims-related inquiries. Responsibilities Analyzing and adjudication of medical claims as it relates to managed care Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes Resolve claims payment issues as presented through the Provider Dispute Resolution (PDR) process or from claims incidents/inquiries Identifies root causes of claims payment errors and reports to Management Responds to provider inquiries/calls related to claims payments Collaborates with other departments and/or providers in the successful resolution of claims-related issues Skills HS Diploma or GED Must have some knowledge of Medi-Cal regulations Must have some Knowledge of medical terminology Must understand to read and interpret DOFRs and Contracts Must have an understanding of how to read a CMS-1500 and UB-04 form Must have strong organizational and mathematical skills Must be able to multi-task Preferred knowledge of Medicare and Commercial rules and regulations Benefits Medical, Dental and Vision insurance 403(b) Retirement savings plans with employer matching contributions Flexible Spending Accounts Commuter Flexible Spending Career Advancement & Development opportunities Paid Time Off & Holidays Paid CME Days Malpractice insurance and tail coverage Tuition Reimbursement Program Corporate Employee Discounts Employee Referral Bonus Program Pet Care Insurance Company Overview AltaMed is one of the nation’s largest community health networks. It was founded in 1986, and is headquartered in Los Angeles, California, USA, with a workforce of 5001-10000 employees. Its website is Company H1B Sponsorship AltaMed Health Services has a track record of offering H1B sponsorships, with 9 in 2025, 5 in 2024, 10 in 2023, 5 in 2022, 2 in 2021, 5 in 2020. Please note that this does not guarantee sponsorship for this specific role.