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Claims Examiner I
Rancho Cordova, California 95670 | Contract To Hire
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!
Wollborg Michelson is building a team of outstanding Claims Examiners for a large healthcare organization.
- 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.
Here are the requirements:
Must have positive, can-do attitude!
Must have previous claims or extensive data entry experience, ideally in insurance or healthcare
Must have minimum High School diploma or GED
Must be able to pass criminal background check
Must have ACCURATE dates of employment on your resume
Must have copy of your resume in a WORD document
Must have solid computer skills and complete our assessment testing prior for consideration with minimum passing scores
Apply now to be considered for this great opportunity!
Regional Program Director
Megan leads an experienced regional recruitment team for strategic accounts in California with a focus on contingent healthcare opportunities. Her expertise includes talent acquisition strategy, implementations, employee relations initiatives and large program management solutions. She has earned a Master of Science in organization development from the University of San Francisco and two Bachelor of Arts degrees from UC Davis.
In her spare time, Megan enjoys exploring the outdoors, music and travel.