Medical Claims Examiner

ONSITE location: Folsom, CA

Monday through Friday | 8am - 5pm

Pay will range between $20 - $26 (dependent on incoming experience)

• Submitting claims while following protocol and ensures audits are completed daily and reports are generated for all products.

• Properly adjudicate claims, respond to inquiries while conducing problem resolution techniques on service issues.

• Daily self-auditing and periodic auditing of submitted claims randomly to ensure quality.

• Ensure proper procedures are followed for adjudications and payments, coordination of benefits and final determination on claims.

• Verifying member benefits, conduct research for proper eligibility requirements.

• Monitor effective dates coincide appropriately with providers contract rates.

• Conducts needed research of data resources, audit results, trends, and root causes to issues.

• Ensuring amounts of refund letters are correctly processed and sent to providers.

• Maintains up to date knowledge of auditing policies and procedures.

• Collaborate and communicate with management teams, on audit findings.

Qualifications:

• REQUIRED – Minimum of 5 years of recent experience in full cycle Medical Claims Examination processing.

• High School Diploma or GED

• Knowledge of CPT, HCPCS, ICD-10 coding

• Knowledge of guidelines for Medical Billing and Payments

• Experience in Microsoft, Excel, Outlook, and Word

• Ability to effectively and efficiently multi-task

• Ability to work individually and collaboratively, with little supervision

• Highly detailed and sense of urgency

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.

Equal Opportunity Employer/Veterans/Disabled

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.lhh.com/us/en/candidate-privacy

The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.