What are the responsibilities and job description for the Claims Examiner position at AppleOne Employment Services?
If you have experience with Anthem Blue Cross claims processing, this is a great opportunity to grow your career in a stable and mission-driven environment.
Position Overview
As a Claims Examiner, you will be responsible for reviewing, processing, and adjudicating medical, dental, and vision claims in accordance with plan documents, policies, and regulatory requirements. You will play a key role in ensuring union members and their families receive accurate and efficient claims service.
Key Responsibilities
Review and process medical, dental, and vision claims
Evaluate claims using plan documents and industry standards
Leverage experience with Anthem Blue Cross systems to resolve discrepancies
Collaborate with internal teams (eligibility, customer service, audit)
Communicate with providers, participants, and union representatives
Apply CPT, ICD-10, and HCPCS codes accurately
Assist with appeals, adjustments, and reprocessing
Maintain HIPAA compliance and confidentiality of sensitive information
Qualifications
Minimum 2 years of claims processing experience with Anthem Blue Cross or a similar major carrier
Strong understanding of health & welfare benefit plans (union experience preferred)
Knowledge of medical billing codes, EOBs, and coordination of benefits
High attention to detail and analytical skills
Excellent communication and organizational abilities
Experience In a TPA Environment Preferred
Proficiency with Microsoft Office and claims systems
Equal Opportunity Employer / Disabled / Protected Veterans
The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf
The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_ English_formattedESQA508c.pdf
For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.
AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf
We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
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Position Overview
As a Claims Examiner, you will be responsible for reviewing, processing, and adjudicating medical, dental, and vision claims in accordance with plan documents, policies, and regulatory requirements. You will play a key role in ensuring union members and their families receive accurate and efficient claims service.
Key Responsibilities
Review and process medical, dental, and vision claims
Evaluate claims using plan documents and industry standards
Leverage experience with Anthem Blue Cross systems to resolve discrepancies
Collaborate with internal teams (eligibility, customer service, audit)
Communicate with providers, participants, and union representatives
Apply CPT, ICD-10, and HCPCS codes accurately
Assist with appeals, adjustments, and reprocessing
Maintain HIPAA compliance and confidentiality of sensitive information
Qualifications
Minimum 2 years of claims processing experience with Anthem Blue Cross or a similar major carrier
Strong understanding of health & welfare benefit plans (union experience preferred)
Knowledge of medical billing codes, EOBs, and coordination of benefits
High attention to detail and analytical skills
Excellent communication and organizational abilities
Experience In a TPA Environment Preferred
Proficiency with Microsoft Office and claims systems
Equal Opportunity Employer / Disabled / Protected Veterans
The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf
The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_ English_formattedESQA508c.pdf
For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.
AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf
We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
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