Description A Healthcare Organization is looking for a Medical Claims Examiner. The Medical Claims Examiner will be responsible for processing, examining, adjudicate and adjust claims . The Medical Claims Examiner will also be responsible for the monitoring of claims to ensure compliance with the Summary Plan Description, Federal and State Mandates, and Quarterly updates as dictated by the Board of Trustees. Key Responsibilities • Generate and utilize claims adjudication reports for identifying claims adjudication errors • Process, examine and adjudicate claims • Facilitate and track the correction of claim adjudication errors • Maintain knowledge of all ICD 10, CPT, HCPCS codes, general billing procedures for Health Care Payers • Test and audit claims payments for accuracy on pre and post payments • Release Held Audits claims for accuracy and consistency • Maintains detailed knowledge & understanding of claims payments • Compile individual’s Audit results to deliver to the Manager • Maintain and update of Claims Manual Processing Guide utilized by the Claims Department • Perform other duties as necessary or assigned by the Claims Manager or Administrative Manager • Maintain required levels of production and quality standards as established by Claims Manager Requirements • Proficiency in claim adjudication and claim denials • Demonstrated experience in conducting claims audits • Comprehensive knowledge of medical claims and medical terminology • Experience in auditing, particularly within the healthcare industry • Familiarity with claim administration processes • Understanding of CPT codes and their application in healthcare claims • Proficiency in using Facets for claim processing • Knowledge of health care audits, particularly in the context of Medicare and Medicaid • Familiarity with health plan processes and regulations • Understanding of ICD-9 codes and their usage in claims processing • Experience handling insurance claims in a healthcare setting • Proficiency in using OnBase for document management • Skilled in Microsoft Excel for data analysis and spreadsheet management • Experience using CMS Platform for content management • Knowledge of Medicare regulations and processes • Experience in managing and creating spreadsheets for data analysis Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. Robert Half will consider for employment qualified applicants with arrest or conviction records in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .