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Claims Examiner

Rancho Cordova, CA

Position: Claims Processor Branch: Rancho Cordova

Wollborg Michelson is currently seeking Claims Examiners in Rancho Cordova for one of the nation's largest healthcare insurance companies! We are looking for candidates with at least 6 months of work experience in claims, medical billing/coding.

Claims Examiner/Processor:

This person will 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.

Job Duties:

  • 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 6 months claims examining experience or completion of a technical class specializing in claims processing required.
  • Experience working with Microsoft applications is preferred.

Nora Kawaguchi
Recruiter

As a South Carolina native, Nora always allows her southern hospitality to shine through all of her encounters. She brings a passion for building meaningful relationships and an enthusiastic personality to the Wollborg Michelson Recruiting team! Nora has a unique background in the performing arts, administrative/ HR support and teaching English in a foreign country. She could be described as adventurous, motivated and a great listener. Nora believes that a smile and positivity go a long way and making a difference in the lives of others is where she truly thrives! 

In her “off” time, Nora is the Sacramento region youth dance coordinator for an international organization that promotes world peace. When she’s not teaching, she is dancing on a semi-pro Latin dance team. Let’s just say that Nora really LOVES to dance! 

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