Medical Claims

  • Location
    Irvine, California
  • Job type
  • Category
    Medical & Science - Administration

Adecco is currently assisting a local client in their search to fill several temp-to-hire Medical Claims positions located in Irvine, CA! This is a long term opportunity for the right person. If you would like to pursue a great opportunity and enjoy working for a fast paced company, then Apply Now if you meet the qualifications listed below!

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This position is responsible for reviewing all processed claims prior to payment release, and respond to all potential health plan capitation deduction report for Health Maintenance Organization (HMO) Enrollees for Medicare and HMO Enrollees.

Specific Duties:
1. Performs routine and moderately complex audits on paper and electronic claims for payment integrity in alignment with regulatory standards and timelines, business policy, contract, appropriate coding, and system configuration with ability to extract and audit exception audit reports.
2 Researches claim processing problems and errors to determine their origin and appropriate resolution. Prepare reports and summarizes observations for management summarizing observations and recommendations.
3. Participates in communication with Business Operations management regarding trends in order to improve claims processing accuracy and documented business rules for incorporation into training programs, policies and procedures.
4. Identifies and escalates issues related to instructional material that is inaccurate, unclear or contains gaps. Provides recommendations for correction of this material. Confers with management to assess training needs in response to changes in policies, procedures, regulations, and technologies.
5. Maintains a minimum audit accuracy rate.

Must have qualifications/experience:
1. Minimum 2+ years Medical Claims experience is required.
2. Experience working with Medicare / Medicaid / HMO
3. Knowledge of healthcare regulations and guidelines including CMS and MHC as pertains to AB1455. Knowledge of Correct Coding Initiative, HCFA-1500 and UB-92 claim forms, and CPT Coding.

Preferred Qualifications:
1. Knowledge of Correct Coding Initiative, HCFA-1500 and UB-92 claim forms and CPT Coding.
2. Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages.
3. Ability to apply common sense understanding to carry out instructions furnished in written, oral, and diagram form.
4. Ability to deal with problems involving several concrete variables in standardized situations.
5. Detail oriented.

Shift Start/End Time: 8:00A to 4:30P

Dress Code: Business casual

Adecco provides one of the most comprehensive benefits packages in the industry to contract employees.

Candidates interested in this Opportunity should apply IMMEDIATELY. DO NOT DELAY. Please click on the “Apply Now” button to fill out your application. If you have any questions, you can contact Kristin Kaiser at

This position is being recruited for by Adecco’s Service Delivery Center, not your local Adecco Branch Office. To be considered for this position, you must use the “apply now” button to submit your resume. If you have questions about the position, you may contact the recruiter recruiting for this position listed above, however your resume must be received via the “apply now” button included within to be considered.

The Adecco Group is a global leader in HR services. Our group connects over 700,000 associates with our business clients each day through our 6,600 offices in over 70 countries and territories around the world. We offer employment opportunities at any stage in your professional career. Contact us today to discuss available contract and direct hire positions. Adecco Group offers benefits including Holiday, 401(k), Insurance Benefit Plans and Service/Anniversary Bonus opportunities.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

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Reference number US_EN_2_286200_402197