Claims Processing Specialist

Rancho Cordova, CA, US • Posted 21 hours ago • Updated 21 hours ago
Contract W2
No Travel Required
On-site
Depends on Experience
Fitment

Dice Job Match Score™

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Job Details

Skills

  • Claims Processing Specialist

Summary

Claims Processing Specialist
Location: Rancho Cordova, CA (onsite)
Contract : 3+ Month (potential to extend)
Work Schedule (Shift/Work Hours):6-2:30 or 7-3:30, M-F  
 
 
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
  • Previorecent 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
IMPORTANT SKILLS:
  • Attention to detail - takes time to review the claim, documents/notes, catch errors and process claims correctly
  • Dental OR Medical/Hospital claims experience
                                             
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
  • Dice Id: 10120741
  • Position Id: DDC-1648
  • Posted 21 hours ago
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