Claims Examiner, Healthcare Insurance Services

Community Health System

Fresno, California

JOB DETAILS
SKILLS
Adjudication, Analysis Skills, Claims Processing, Community Health, Diversity, Health Insurance, High School Diploma, Hospital, Medical Billing, Medical Coding, Medical Terminology, Quality of Care, Scholarship, Software Administration, Tuition Reimbursement
LOCATION
Fresno, California
POSTED
3 days ago
Overview:

Opportunities for you! 

  • Consecutively recognized as a top employer by Forbes, and in 2025 by Newsweek 
  • Free Continuing Education and certification  
  • Tuition reimbursement, education programs and scholarships 
  • Vacation time starts building on Day 1, and builds with your seniority 
  • Free money toward retirement with a 403(b) and matching contributions 
  • Great food options with on-demand ordering 
  • Free parking and electric charging 

 

Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community. 

We know that our ability to provide the highest level of care is through taking care of our incredible teams. Learn more on our Benefits page. 

Responsibilities:
The Claims Examiner is responsible for accurately processing professional and hospital claims for Community Care Health (CCH) for in-network and out-of-network providers. This role will review and analyze claims: verifying coverage, assessing eligibility, and determining the validity of claims based on policy terms.
 
 
Qualifications:
Education
  • High School Diploma, High School Equivalency (HSE) or Completion of a CHS Approved Individualized Education Plan (IEP) Certificate required
  • Associate's Degree preferred
 
Experience
  • 1 year of medical claims processing/adjudication experience 
  • Experience working with claims system/applications and troubleshooting preferred
  • Trizetto/QNXT software experience preferred
  • Experience using Blue Shield or Anthem portals (e.g., verifying member eligibility, checking claim statuses, or tracking payments).
  • Medical Coding/Billing knowledge

  • Medical Terminology knowledge 

Disclaimers:

• Pay ranges listed are an estimate and subject to change.
• If any bonuses are noted, they are only applicable to external hires meeting criteria.

About the Company

C

Community Health System

Community Health Systems, Inc. is a non-profit 501 (c) (3) 330 HRSA Grantee with Federally Qualified Health Center (FQHC) status. Established from the roots of Inland Empire Community Health Center in Bloomington, CHSI has grown with community health centers in the counties of Riverside, San Bernardino, and San Diego. These centers have been developed in accordance with standards established for safety net providers by the U.S. Department of Health and Human Services (HHS), the Health Resources Services Administration (HRSA), the Public Health Service (PHS), and the Bureau of Primary Health Care (BPHC).

As such, services are offered to the neediest in each community - the un-insured and under-insured, the working poor, those with limited ability to pay, the homeless, and the indigent. Services are provided at discounted (sliding fee scale) rates for those who qualify based on gross annual income and family size.

COMPANY SIZE
10,000 employees or more
INDUSTRY
Healthcare Services
FOUNDED
1985
WEBSITE
http://www.chs.net/