Claims Examiner, Healthcare Insurance Services

Community Health System • Fresno, CA

5d • $23 - $29

About The Position

The Claims Examiner is responsible for accurately processing professional and hospital claims for Community Care Health (CCH) for in-network and out-of-network providers. This role will review and analyze claims: verifying coverage, assessing eligibility, and determining the validity of claims based on policy terms.

Requirements

• High School Diploma, High School Equivalency (HSE) or Completion of a CHS Approved Individualized Education Plan (IEP) Certificate required
• 1 year of medical claims processing/adjudication experience
• Medical Coding/Billing knowledge
• Medical Terminology knowledge

Nice To Haves

• Associate's Degree preferred
• Experience working with claims system/applications and troubleshooting preferred
• Trizetto/QNXT software experience preferred
• Experience using Blue Shield or Anthem portals (e.g., verifying member eligibility, checking claim statuses, or tracking payments).

Responsibilities

• Accurately processing professional and hospital claims for Community Care Health (CCH) for in-network and out-of-network providers.
• Review and analyze claims: verifying coverage, assessing eligibility, and determining the validity of claims based on policy terms.

Benefits

• Free Continuing Education and certification
• Tuition reimbursement, education programs and scholarships
• Vacation time starts building on Day 1, and builds with your seniority
• Free money toward retirement with a 403(b) and matching contributions
• Great food options with on-demand ordering
• Free parking and electric charging
• Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community.
• We know that our ability to provide the highest level of care is through taking care of our incredible teams. Learn more on our Benefits page.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED