PC
Medical Claims Processor
Pyramid Consulting, Inc
- 🇺🇸 United States
- On-site
- 7 hours ago
- medical billing
- Health insurance
7 hours ago
Not enough detail in this posting to match
Job ID:26-32237
Pay Range: $28 - $29/hour. Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)
Key Responsibilities:
- Receive, review, and process medical claims and bills to determine appropriate payment or denial.
- Examine claim records for completeness, accuracy, and required supporting documentation.
- Research claims and billing information to identify missing documents, discrepancies, and processing exceptions.
- Analyze claim data and apply applicable benefit criteria and payment guidelines to determine appropriate claim outcomes.
- Review claim information and make adjustments in accordance with established procedures.
- Investigate vendor and member questions, concerns, complaints, and claim-processing issues.
- Research payment discrepancies and help resolve outstanding claim questions.
- Obtain or verify additional documentation needed to support claim review and adjudication.
- Maintain accurate records of claims reviewed, adjustments made, research performed, and resolutions.
- Communicate clearly with relevant internal teams and external vendors to facilitate claim resolution.
- Follow established procedures for handling confidential healthcare and member information.
- Manage assigned work efficiently while maintaining accuracy, organization, and timely follow-up.
- High School Diploma or equivalent.
- 2–3 years of experience in medical claims processing, claims adjudication, claims examination, medical billing, or a closely related healthcare administrative role.
- Practical experience reviewing medical claims, bills, or supporting documentation.
- Ability to research discrepancies and determine appropriate next steps for claim resolution.
- Familiarity with payment and denial processes and the application of benefit criteria or claim-processing guidelines.
- Strong attention to detail and analytical problem-solving skills.
- Effective written and verbal communication skills.
- Good organizational skills and the ability to manage multiple tasks.
- Ability to handle confidential healthcare and member information appropriately.
- Ability and willingness to work onsite in Bakersfield, CA, and participate in an onsite interview.
- Experience with health insurance claims or healthcare payer operations.
- Familiarity with claims management systems, billing platforms, or electronic claims-processing systems.
- Experience handling claim exceptions, payment discrepancies, documentation requests, and vendor or member inquiries.
- Experience working in a structured healthcare administrative or claims-processing environment.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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Medical Claims Processor · Pyramid Consulting, Inc