Claims Processing Specialist

Claims Processing Specialist

Location: Rancho Cordova, CA (Resources are required to work 100% onsite in Rancho Cordova from 6:00AM - 2:30PM) Contract: 6+ Months

Job Description: The Claims Processing Specialist identifies and provides solutions for processing unique claims, refunds, overpayments, and underpayments. Other duties include processing special claims which may involve manual review of actual treatment compared to authorized treatment, and adjudicating VA CCN claims.

Essential Duties:

• Performs analysis of authorizations compared to submitted claims.
• Processes special claim payments, specifically for VA CCN client.
• Processes returned client checks, personal checks, undeliverable checks, stale dated checks, and requests for voids/stop-payments/re-issues. Determines refund amounts, changes status of outstanding overpayments.
• Reviews monthly reports for outstanding overpayments and coordinates with finance on special issues.
• Reviews and handles special professional reviews and service issues, quality complaints and coordinates with Special Correspondence Unit.
• This list is not all-inclusive and you are expected to perform other duties as requested or assigned

Skills/Experience: Minimum Qualifications

• 2+ years of experience w/High School Diploma/GED
• Previous/recent experience in claims processing
• Ideal to have Dental Claims processing experience
• High attention to detail
• Some customer service experience and claims adjudication experience including the understanding of re-adjudication is preferred.

Additional Experience:

• Proficient in MS Excel
• Strong analytical and critical thinking skills.
• Ability to maintain strict attention to detail.
• Excellent customer service skills with ability to evaluate and respond to the contact needs.
• Ability to independently prioritize work and establish, understand, and follow work rules and procedures, and take action to improve existing processes.
• Ability to confront difficult situations and make appropriate and timely decisions.
• Excellent organizational skills, including the ability to follow-up on commitments on a timely basis and adhere to deadlines.
• Ability to collaborate effectively with others.
• Basic knowledge of accounting principles.
• Knowledge of Enterprise policies, procedures, and guidelines

Pay Transparency: "The expected pay range for this position is $25.00–$28.00 per hour. Final compensation will be determined based on experience, skills, and qualifications. Non-exempt employees are eligible for overtime. Full-time employees are eligible to select from different benefits packages. Packages may include medical, 401(k) without employer match. Paid Sick leave is provided based on state or local laws.