UCLA Health

Claims Examiner III - Medicare Advantage

UCLA Health  •  $30.36 - $43.49/hr  •  Remote  •  4 months ago
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Job Description


General Information

Work Location: Los Angeles, CA, USA
Onsite or Remote
Flexible Hybrid
Work Schedule
Monday - Friday, 8:00am-5:00pm PST
Posted Date
01/20/2026
Salary Range $30.36 - 43.49 Hourly
Employment Type
2 - Staff: Career
Duration
Indefinite
Job #
28296


Primary Duties and Responsibilities

Take on a key role within a world-class, award-winning health system. Contribute to the delivery of award-winning patient care. Take your career in an exciting new direction. You can do all this and more at UCLA Health.

You will be responsible for accurate and timely data entry, and the review and adjudication of professional, ancillary, and institutional claims for services rendered in our inpatient, ambulatory and outpatient settings. This will cover all contracted lines of business in accordance with regulatory guidelines, contract provisions, and established policies and procedures. Working from batches, reports, in-basket pools, work queues, or other methods, you will be called on to meet established quality, productivity, service level, and turn-around requirements. This role requires the ability to research and resolve complex claim issues as well as train others on claims processes and workflows.

Salary Range: $30.36 - $43.49/Hourly


Job Qualifications


We’re seeking a self-motivated, detail-oriented, deadline-driven individual with:

  • High School Diploma, GED or equivalent experience
  • Four or more years of medical claims payment experience in an HMO setting
  • Expertise in industry standard claims adjudication policies, procedures, and processes
  • In-depth knowledge of fee schedule and pricing methodologies for outpatient/inpatient institutional, ancillary, and professional claims
  • Experience processing complex institutional claims
  • Understanding of CPT, HCPCS, ICD-10, ASA, and revenue codes
  • Knowledge of medical terminology
  • Ability to accurately key 6,000-8,000 keystrokes or type 40-50 WPM
  • Computer proficiency with Microsoft Office and data visualization tools
  • Knowledge of claims adjudication systems (e.g., EPIC-Tapestry, EZ Cap, QNXT, IDX)
  • Willingness to learn new technologies, practices, and procedures
  • Strong problem identification, resolution, and analytical abilities
  • Excellent communication, interpersonal, critical thinking and organizational skills

UCLA Health is a world-renowned health system with four award-winning hospitals and dozens of primary care practices, specialty practices, urgent care centers, and other ancillary locations throughout metro Los Angeles. We’re also home to the world-class medical research and clinical education capabilities of the David Geffen School of Medicine. Through the efforts of our outstanding people, we have become Los Angeles’ trusted provider of exceptional, compassionate patient care. If you’re looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.

UCLA Health

About UCLA Health

For more than half a century, UCLA Health has provided the best in healthcare and the latest in medical technology to the people of Los Angeles and throughout the world.

Comprised of Ronald Reagan UCLA Medical Center, UCLA Medical Center Santa Monica, Resnick Neuropsychiatric Hospital at UCLA, UCLA Mattel Children's Hospital, UCLA West Valley Medical Center and the UCLA Medical Group with its wide-reaching system of primary-care and specialty-care offices throughout the region, UCLA Health is among the most comprehensive and advanced healthcare systems in the world.

Our physicians are world leaders in the diagnosis and treatment of complex illnesses, and our hospitals are among the best in the country. Consistently ranked one of the top ten hospitals in the nation and the best medical center in the western United States by U.S. News & World Report, Ronald Reagan UCLA Medical Center is at the cutting edge of biomedical research, and our doctors and scientists are leaders in performing pioneering work across an astounding range of disciplines, from organ transplantation and cardiac surgery to neurosurgery and cancer treatment, and bringing the latest discoveries to virtually every field of medicine.

Industry
Healthcare & Social Services
Company Size
10,000+ employees
Headquarters
Los Angeles, CA
Year Founded
1955
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