Exciting Claims Processing Coordinator opportunity with our insurance client in Rancho Cordova CA.
Contract Duration: 2-3 months
This position is 100% onsite role, 5 days a week starting at 6:00 or 7:00 a.m. each day in Rancho Cordova, CA
Required Skills & Experience
JOB SUMMARYT: 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.
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
• 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.
What You Will Be Doing
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
