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Claims Examiner I

Rancho Cordova, California 95670 | Contract To Hire

Job ID: 56098 Position: Claims Processor Branch: Rancho Cordova

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.

DESCRIPTION
  • 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!

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