Claims Examiner I

Western Growers

Claims Examiner I responsible for processing claims for medical, dental, and vision. Join Western Growers Health to support the agriculture industry's health benefit needs.

Posted 4/29/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $40,580 - $52,756 per yearWebsite

About the role

Key responsibilities & impact

The Claims Examiner I reports to the Supervisor of Claims.
Claims Examiner I is responsible for reviewing and processing medical, dental, vision, and electronic claims per state, federal, and health plan regulatory requirements and department guidelines, as well as meeting established quality and production performance benchmarks, including research and review of applicable documentation.
The Claims Examiner I will thoroughly review, analyze, and research health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment.
The position will assist in resolving issues from providers, customer service, member services, health plan, and other internal customers.

Requirements

What you’ll need

High school education or equivalent: minimum three (3) to five (5) years of experience as a Health Claims Examiner or comparable industry experience preferred.
A minimum of one (1) year experience as a Claims Examiner for medical, dental claims and vision, subrogation, and accident claims, highly desired.
Ability to interpret Plan Documents or Summary Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination
Basic knowledge of medical terminology. Familiar with UB-04 and HCFA 1500 forms (837/5010 format), ICD10, CPT, and HCPCS codes.
Good verbal and written communication skills.
Proficient in 10-key by touch data entry/type 40 WPM and Microsoft Office (Word, Excel, Outlook, PowerPoint) and possess a capability to quickly learn new applications.
Ability to work under pressure and adapt to changing environment
Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines.
Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
Home router with wired Ethernet (wireless connections and hotspots are not permitted).
A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
A functioning smoke detector, fire extinguisher, and first aid kit on site.

Benefits

Comp & perks

rich benefits package that includes profit-sharing

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

claims processingmedical terminologydata entryICD10 codingCPT codingHCPCS codingUB-04 formHCFA 1500 formsubrogation claimsaccident claims

Soft Skills

verbal communicationwritten communicationability to work under pressureadaptability