Claims Examiner – DaysLOCATION: 9557 Greenleaf Avenue, Whittier, CASHIFT: Monday - Friday - 07:00am - 03:30pmPLEASE NOTE ORIENTATION TIME MAY DIFFER THAN SHIFT TIMES LISTEDDURATION - 13 weeks2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA OR GED OR HIGHER EDUCATIONPosition Summary:The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.Education/Experience/Training:High school graduate or equivalent required. Must have physical proof on hand if background check is unable to verify your education background.Minimum of 2 years claims adjudication related experience in ambulatory, acute care hospital, HMO, or IPA environmentKnowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary ServicesKnowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claimsKnowledge of compliance issues as they relate to claims processingExperience in interpreting provider contract reimbursement terms desirableAbility to identify non-contracted providers for Letter of Agreement considerationData entry experienceTraining on basic office automation and managed care computer systemsRTO MUST BE SUBMITTED AT TIME OF SUBMITTAL, NO EXCEPTIONSAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.