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Claims Analyst (1110322)

Rancho Cordova, CA 95670

Employment Type: Contract Position: Claims Processor Job Number: 57249 Branch: Rancho Cordova

Wollborg Michelson is building a team of outstanding Claims Analyst  for a renowned healthcare insurance company located in Rancho Cordova, CA. We are interviewing Monday-Friday as the client would like to meet candidates immediately! These positions are contract to hire in a short term which means that you may have the opportunity to convert to a permanent employee within 4-6 months with excellent performance and attendance.

Find Your Dream Job

Finding a Dream Job can feel a lot like searching for a needle in a haystack. We start by viewing each candidate as an individual, identifying their distinct strengths and guiding them to the right opportunities. We' re also big believers in mentoring our candidates and creating long-term relationships. Helping you find your Dream Job is really just the start. We want to help you build a Dream Career!


Description

Position Purpose: Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures.
  • Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied. Claims processing may be related to physician and hospital services, coordination of benefits (COB), high dollar, special pricing, refunds and/or adjustments on resubmitted claims.
  • Research and determine status of medical related claims
  • Review charges, access the computer system and use payment or denial codes within established department guidelines and standards
  • Clarify health insurance coverage for coordination of benefits to process claims
  • Maintain records, files, and documentation as appropriate
  • Meet department production and quality standards

Qualifications

Education/Experience: High school diploma or equivalent. 1+ years of claims processing, medical billing, administrative, customer service, call center, or physician’ s office or other office services experience. Experience operating a 10-key calculator and computers. Ability to perform basic math functions and reason logically. Working knowledge of ICD-9, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims preferred.

Jessica Hunt-West
Senior Program Manager

Jessica obtained her Bachelor’s Degree in Biological Sciences from California State University, Sacramento and a Master’s Degree in Forensic Science from National University. She began her career in Post-Secondary Education, providing Career Counseling and Workforce Training to graduates. Jessica has over 8 years of business development and recruitment experience. She has worked in Staffing & Career Services providing workforce development and strategic staffing support to small, medium and large companies. 

In addition to her professional pursuits, Jessica often indulges in her love for travel and travels throughout the country conducting motivational talks & presentations to small and large groups on a variety of topics. 

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