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Claims Examiner I (RC)
Rancho Cordova, California | [Contract]
- 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
- 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.