Job Title: Remote Medical Claims Examiner (Medi-Cal / Managed Care)
Location: Fully Remote (Must work Pacific Time hours)
Schedule: Flexible start time between 6:00 AM - 9:00 AM PST, Monday-Friday
Pay: $22-$25/hour (based on experience)
Employment Type: Full-Time | Benefits + PTO | Remote Equipment Provided
Are you an experienced Claims Examiner looking to work from home with a supportive, well-established team? We are seeking a motivated and detail-oriented individual who thrives in a fast-paced, mission-driven environment.
Key Responsibilities
Review and adjudicate 100-150 medical claims per day in accordance with health plan contracts and regulatory requirements.
Manually price claims and interpret complex contracts for Medi-Cal, Medicare, and commercial lines of business.
Investigate provider inquiries and assist with claims research across departments.
Ensure compliance with internal policies, provider agreements, and CMS/DHCS regulations.
Collaborate on process improvement and assist with training new team members.
Participate in meetings and contribute to a positive team culture.
What You Bring
Must-Have:
1+ year of experience as a Claims Examiner using an automated claims adjudication system
Strong experience with Medi-Cal, and familiarity with Medicare and commercial claims
Knowledge of medical coding (ICD, CPT, HCPCS) and ability to identify missing codes
Ability to independently research and apply contract terms to adjudicate claims
Experience in managed care settings
High school diploma or GED
Nice to Have:
Experience adjudicating multiple client/provider claims
Familiarity with provider contracts and fee schedules
Strong communication and collaboration skills
Why Join Us?
Fully Remote: Work from the comfort of your home (equipment provided!)
Flexible Schedule: Choose your start time between 6-9 AM PST
Growth Opportunities: Leaders have all worked their way up internally
Positive Culture: Team-building activities, holiday contests, and a collaborative spirit
Competitive Benefits & PTO
Start your next chapter with a company that values your experience and offers room to grow.
Apply today and bring your skills to a high-performing, compassionate team.
For California Applicants:
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
Company Description
Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.
Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?
