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Medical Claims Examiner (Healthcare Industry)

Woodland Hills, CA

Position: Healthcare

Job Description

Wollborg Michelson is partnering with a well-establish healthcare company located in Woodland Hills, CA to locate a team of Medical Claims Examiners. The position is a 6-month contract to hire role! If you meet the qualifications, please apply with an up to date resume!

PURPOSE

Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.Will be part of the commercial case management team. Will be supporting the UM team and case management team. Support w/certain tasks. Senior PC will be assigning smaller tasks to this temporary worker. They may be assigned to a certain queue, reviewing letters/eligibility.

JOB RESPONSIBILITIES:

  • A-Level professional with 3-6 years of experience in healthcare claims processing
  • Processing and adjudicating medical claims.
  • Maintaining integrity of claims receipts in accordance with standard claims operating and adjudication procedures.
  • Accurately resolving pending claims using state and federal regulations and specific health plan criteria.
  • Working within quick turnaround times to meet client performance guarantees for claims processing.
  • Screen members by priority for case management (CM) assessment.
  • Produces and mails routine CM letters and program educational material.
  • Data entry assessments and authorizations into the system.

REQUIREMENTS

  • Thorough knowledge of customer service, utilization review or claims processing practices in a managed care
  • Familiarity talking with members/providers
  • Knowledge of medical terminology.0-2 years of experience
  • Strong computer skills – MS Office Ste., Data Entry, Typing
  • High school diploma or equivalent.

Hours: Mon - Fri 7a-5p plus required OT and possible weekends as needed

Job Type: 6-month TEMP TO HIRE

PLEASE APPLY HERE TODAY!

Meet Your Recruiter

Alana Klingman
Branch Manager

Alana is a native Huntington Beach resident making the move to Sacramento just a few years ago. She comes with over 15 years of experience in full cycle healthcare recruiting and thoroughly enjoys every aspect of her job. Receiving a new client order and placing a qualified applicant is truly an excitement each and every time. Her goal at the end of every day is to leave a positive impression with everyone she works with including letting the candidates know that she is on their side. She strives to fill every client need that comes across her desk with a candidate that can call that place of business HOME. When she is not hard at work Recruiting, Alana spends her free time attending local family events, trying new eateries and perfecting DIY home projects she found on Pinterest.

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