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Medical Claims Processor
Rancho Cordova, CA 95670
Wollborg Michelson is currently seeking Claims Examiners in Rancho Cordova for one of the nation's largest healthcare insurance companies! Candidates with at least 6 months of work experience in claims, medical billing/coding preferred.
- 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.
- 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.
Born and raised in the beautiful foothills of El Dorado County, Seren has spent the last decade living in various states and countries before returning to her native roots in Sacramento. She started her career working on site for a NGO in the nonprofit industry establishing projects and sustainable relief programs in Uganda, East Africa. From there her experience expanded out to working as a Client Relations Manager in a Top 10 National CPA firm and then moved towards HR in the administration of benefits and insurance. She first worked in recruiting at Sutter Health and gained a passion for the opportunities that this industry has to offer while focusing on process improvement and project management. The best part of recruiting for Seren is finding great candidates and connecting them with a position that will not only fulfill their professional needs but also enable them to provide for their families and their future.
In her spare time Seren enjoys going to the movies, participating in outdoor sports like rock climbing, mountain biking and trail running, and hiking with her husband and two dogs; a Black Labrador named Penny and a Jack Russell Terrier named Buster. They are expecting their first child in December and can’t wait to take their baby boy on hikes with the family!