Medical Claims Examiner

Job overview

The Medical Claims Examiner role is onsite in Fremont, CA. The schedule is Monday through Friday, 8:30 AM to 5:00 PM, in eight-hour shifts; compensation is $41.85 per hour. Cornerstone Staffing Solutions is recruiting for an established healthcare benefits administration organization. The examiner reviews and adjudicates professional and institutional healthcare claims under benefit plans, policies, contracts, regulatory requirements, and internal guidelines. The role supports accurate, timely, compliant claim decisions and clear service to members, providers, and internal teams.

What you'll do

• Review and adjudicate professional and institutional medical claims
• verify eligibility, coverage, and plan provisions
• assess claim completeness, coding, and documentation
• interpret benefits and cost-sharing
• determine payment, denial, pend, or information-request actions
• apply coordination-of-benefits guidelines
• research complex claims
• document decisions and communications
• process corrected claims and adjustments
• communicate with providers, members, and internal teams
• protect confidential health information under HIPAA.

What we're looking for

Skills & competencies

medical claims examiner

full-time

monday–friday

8:30 am–5:00 pm

fremont ca

cornerstone staffing solutions

claims adjudication

healthcare benefits

cpt

hcpcs

icd-10-cm

$41.85/hr

Work arrangement

• Weekend coverage required

Why this role

Contract-to-hire opportunity; Monday–Friday schedule; eight-hour shifts from 8:30 AM to 5:00 PM.

About the employer

Cornerstone Staffing Solutions Inc is hiring for this role. Industry: Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds. Sector: 52.