Senior Claims Specialist – Claims Processing

Providence

Senior Claims Specialist responsible for processing complex institutional claims at Providence Medical Foundation. Requires knowledge of compliance issues related to claims processing and provider contracts.

Posted 5/2/2026full-timeAnaheim • California • 🇺🇸 United StatesSenior💰 $26 - $40 per hourWebsite

About the role

Key responsibilities & impact

Responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.)
Adjudication and claims research when necessary
Knowledge of compliance issues as they relate to claims processing
Ability to identify and address non-contracted providers.

Requirements

What you’ll need

2 years Claims pricing and processing experience in ambulatory, acute care hospital, HMO or IPA environment
Experience processing all types of medical claims outpatient/inpatient UB-04 and HCFA-1500 claims as well as others.
Experienced in interpreting provider contract reimbursement terms.

Benefits

Comp & perks

Health care benefits (medical, dental, vision)
Life insurance
Disability insurance
Retirement 401(k) Savings Plan with employer matching
Paid parental leave
Paid vacations
Paid holidays
Time off benefits
Wellness resources
Voluntary benefits

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims processingclaims pricingadjudicationclaims researchmedical claims processingUB-04 claimsHCFA-1500 claimsprovider contract interpretation

Soft Skills

problem-solvingattention to detail