Claims Processing Specialist​/Onsite​/Rancho Cordova, CA

About the Role

Our client, a leading insurance provider and dental network, is seeking a Claims Processing Specialist. This is an onsite role in Rancho Cordova, CA.

contract duration: 3 months (+ extensions)

• 2+ years of experience w/High School Diploma/GED
• Previous/recent experience in claims processing - dental or medical/hospital claims
• 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.
• 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’s 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

• Performs analysis of authorizations compared to submitted claims.
• Processes special claim payments, specifically for VA CCN client.
• Processes returned company checks, personal checks, undeliverable checks, stale dated checks, and requests for voids/stop-payments/re-issues.
• Determines refund amounts, changes status of outstanding over payments.
• Reviews monthly reports for outstanding over payments and coordinates with finance on special issues.
• Reviews and handles special professional reviews and service issues, quality complaints and coordinates with Special Correspondence Unit.
• Other duties as requested or assigned.