What are the responsibilities and job description for the Claims Auditor position at Pacer Group?
Job Title :
Claims Auditor / Claims Processor
Location: Whittier, CA
Start Date: (Immediate Start)
Duration: 13 weeks
Schedule Shift: Days | 7:00 AM – 3:30 PM | 8-hour days | 40-hour guarantee
Pay Rate:
$30/hour
Description
:
TITLE: Claims Auditor / Claims Processor
PIH Health Physicians is seeking an experienced
Claims Auditor / Claims Processor
to support the Claims Department. This role is ideal for professionals with strong medical claims processing experience and knowledge of HMO/IPA operations, Medicare, and Medi-Cal guidelines.
EDUCATION/EXPERIENCE/TRAINING
Required
:
- High School Diploma or equivalent
- Minimum 4 years of medical claims processing experience
- Knowledge of:
- HMO and/or IPA operations
- Medical terminology
- ICD-10, CPT, RVS coding
- Medicare & Medi-Cal guidelines
- Strong 10-key skills (by touch)
- Excellent organizational, communication, and time-management skills
- Ability to meet deadlines in a fast-paced environment
DUTIES AND RESPONSIBILITIES
- Ensure confidentiality of patient protected health information (HIPAA compliant)
- Assist the Claims Director with training and education of Claims staff
- Coordinate, generate, and review claims audits, pending claims, and status reports
- Investigate and process payment adjustments (refunds, overpayments, underpayments)
- Serve as a professional resource for providers, members, insurance carriers, and staff
- Research and respond to claims-related inquiries in a timely manner
- Create and maintain system-generated reports
- Support compliance with legal, regulatory, and contractual audit requirements
- Prepare and present weekly and monthly quality and performance reports
- Review and audit member liability denials and Provider Dispute Resolution claims
- Perform additional duties as assigned
Salary : $30