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Claims Examiner I (RC)

Rancho Cordova, California 95670 | [Contract]

Job ID: 55732 Position: Claims Processor Branch: Rancho Cordova
Wollborg Michelson Recruiting is supporting a large health insurance provider and building a team of claims examiners.  
  • Under close supervision, this position processes routine claims within a single product line to determine type and amount of benefit payable.
  • Performs limited duties, subject to review and approval, for the processing of such claims assigned, consistent with applicable policies, procedures and department guidelines.
  • Determines level of reimbursement based on established criteria, provider contract, plan and employer group provisions.
  • Processes all claims eligible or ineligible for payment accurately and conforming to quality, production standards and specification.
  • Matches authorizations to claims, maintains current desk procedural and reference materials.
  • Reviews appeals and complaints; researches any missing or required information. Responds by telephone or in writing to providers, members, or other company departments to process and resolve the claim issues
  • Education/Experience:
  • High School diploma or equivalent required.
  • Minimum six months claims examining experience or completion of a technical class specializing in claims processing required.
  • Experience working with Microsoft applications is preferred.
  • Overtime and weekend work required.
  • Must have a positive attitude and be flexible in a dynamic environment as priorities and directives change.
Great attitude, reliable, basic excel

Heather Keller
Vice President of Operations

Heather has over twelve years of pharmaceutical and medical device staffing and consulting experience gained from roles with global staffing and professional services firms. Heather's focus is on strengthening client relationships to become a trusted partner and talent advisor. Heather’s expertise includes developing creative and efficient sourcing and recruitment processes, uncovering channels of top talent for hard to fill roles and optimizing organizational design in order to deliver top talent to clients. Prior to joining the staffing industry, she conducted biomedical research and conducted drug target validation studies. Heather has a bachelor of science in Biological Sciences from UC Davis with an emphasis in Neurobiology, Physiology and Behavior.

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