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Claims Examiner - Healthcare
Rancho Cordova, CA 95670
Wollborg Michelson is building a team of outstanding Claims Examiners for a renowned healthcare insurance company located in Rancho Cordova, CA.
-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 one year claims examining experience or completion of a technical class specializing in claims processing required.
-Experience working with Microsoft applications and knowledge of medical terminology is desired.
A graduate of Tennessee State University and Seton Hall University, Christine is a native Californian and can best be described as enthusiastic and self-motivated. She comes to Wollborg Michelson with more than 10 years of corporate and nonprofit experience in Communications and Marketing, and gladly welcomed the opportunity to transition to the Recruiting industry. During her career, she spent time working in Corporate Communication, Event Management and Public Relations. She enjoys meeting new people and looks forward to using her skills to thrive in Recruiting.
In her spare time, Christine can be found reading, traveling, participating in community service activities, and trying new restaurants.