- Analyze claims for appropriate payer, based on a combination of coding, medical group's service area, and contract per the Division of Financial Responsibility (DoFR) document.
- Make claim payment determinations.
- Process claims, and make payment adjustments as necessary.
- Process member reimbursement claims.
- Consistently maintain the department audit scores.
- Forward misdirected claims to the appropriate payer.
- Finalize commercial claims for payment or denial.
- Finalize Employee Retirement Income Security Act (ERISA).
- Ensure that clean claims are paid within 30 calendar days of receipt.
- High School Diploma.
- 1 year experience working with claims adjudication in the health care industry, preferably HMO.
- Ability to identify the difference between to International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and Revenue (Rev) Codes.
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Claims Examiner
2 weeks ago
Insight Global Sacramento, United StatesDay to Day: · The Claims Examiner 1 is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. They will need to process claims by performing the following duties: Adjudicating medical claims, applying coordination of benefits as ...
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Claims Examiner
2 weeks ago
Insight Global Sacramento, United StatesDay to Day: · The Claims Examiner 1 is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. They will need to process claims by performing the following duties: Adjudicating medical claims, applying coordination of benefits a ...
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Medical Claims Examiner
2 weeks ago
Ultimate Staffing Services Sacramento, United StatesJob Description · Job DescriptionLooking for a medical claims examiner for a wonderful health insurance company here in Sacramento. · Pay is $18-$22 an hour DOE · Must have 1 year of claims experience, ability to identify different billing codes, processing claims and making nece ...
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Medical Claims Examiner
1 day ago
Benefit & Risk Management Services, Inc. Sacramento, United StatesJob Description · Job DescriptionSummary: The Claims Examiner I is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. Processes claims by performing the following duties. · ****This Not a Remote Position**** · Essential Duti ...
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Claims Examiner
1 week ago
Insight Global Folsom, United StatesInsight Global is looking for a Claims Examiner for one of their insurance clients in Folsom, CA. This is a fully onsite role, 5 days a week onsite. This person will be responsible for ensuring claims are coded and processed correctly while meeting production requirements. This p ...
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Claims Examiner
1 week ago
Insight Global Folsom, United StatesThe Claims Examiner is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. They will need to process claims by performing the following duties: Adjudicating medical claims, applying coordination of benefits as outlined in pla ...
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Medical Claims Examiner
2 weeks ago
Ultimate Staffing Sacramento, United StatesLooking for a medical claims examiner for a wonderful health insurance company here in Sacramento. · Pay is $18-$22 an hour DOE · Must have 1 year of claims experience, ability to identify different billing codes, processing claims and making necessary adjustments and payments. · ...
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Medical Claims Examiner
2 weeks ago
Ultimate Staffing Sacramento, United StatesLooking for a medical claims examiner for a wonderful health insurance company here in Sacramento. Pay is $18-$22 an hour DOE Must have 1 year of claims experience, ability to identify different billing codes, processing claims and making necessary Claims, Medical, Examiner, Heal ...
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Claims Examiner
1 week ago
Health Advocates Network, Inc. Folsom, United States ContractHealth Advocates Network is hiring a Denials Analyst(2 Years Exp Req) This is a full-time contract position at a nationally recognized hospital located in Folsom, CA. · Pay Rate: $24.00/hour · Shift: Days (8hrs) · Start Date: ASAP · Contract Length: 13 weeks · Job Summary: Respo ...
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Health Claims Examiner
2 weeks ago
LHH Recruitment Solutions Sacramento, United StatesJob Description · Job DescriptionAre you skilled in claim adjudication, submissions, or claim reviews? Join our team in Sacramento, CA, and contribute to accurate billing and payments aligned with contractual agreements. If you are dedicated and passionate about the industry, ple ...
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Claims Examiner
1 week ago
Health Advocates Network, Inc. Folsom, United StatesJob Description · Health Advocates Network is hiring a Denials Analyst (2 Years Exp Req) This is a full-time contract position at a nationally recognized hospital located in Folsom, CA. · Pay Rate: $24.00/hour · Shift: Days (8hrs) · Start Date: ASAP · Contract Length: 13 weeks · ...
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Claims Examiner
1 week ago
Health Advocates Network, Inc. Folsom, United StatesHealth Advocates Network ishiring a Denials Analyst (2 Years Exp Req) This is a full-time contract position at a nationally recognized hospitallocated in Folsom, CA. · Pay Rate: $24.00/hour · Shift: Days (8hrs) · Start Date: ASAP · Contract Length: 13 weeks · Job Summary: R ...
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Claims Examiner
1 day ago
Health Advocates Network Folsom, United StatesHealth Advocates Network is hiring a Denials Analyst (2 Years Exp Req) This is a full-time contract position at a nationally recognized hospital located in Folsom, CA. · Pay Rate: $24.00/hour · Shift: Days (8hrs) · Start Date: ASAP · Contract Length: 13 weeks · **Job Summary ...
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Claims Examiner III
16 hours ago
Tristar Insurance Services LLC Rancho Cordova, United StatesJob Details · Level · Experienced · Job Location · Sacramento - Rancho Cordova, CA · Remote Type · Optional Work from Home · Position Type · Temporary · Education Level · High School Diploma or GED · Salary Range · $ $44.23 Hourly · Travel Percentage · None · Job Sh ...
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Claims Examiner
1 week ago
Insight Global Folsom, United StatesJob Description · Job DescriptionTitle: Claims Examiner 1 · Company: BRMS · Duration: PERM · Pay rate: $ $26.00/hr · Location: 5 days a week onsite · Day to Day: · The Claims Examiner 1 is responsible for ensuring claims are coded and processed correctly and for meeting producti ...
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Claims Examiner
1 week ago
Insight Global Folsom, United StatesJob Description · Job DescriptionTitle: Claims Examiner 1 · Company: BRMS · Duration: PERM · Pay rate: $ $26.00/hr · Location: 5 days a week onsite · Day to Day: · The Claims Examiner 1 is responsible for ensuring claims are coded and processed correctly and for meeting producti ...
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Claims Examiner
2 weeks ago
Insight Global Folsom, United StatesJob Description · Job DescriptionTitle: Claims Examiner 1 · Company: BRMS · Duration: PERM · Pay rate: $ $26.00/hr · Location: 5 days a week onsite · Day to Day: · The Claims Examiner 1 is responsible for ensuring claims are coded and processed correctly and for meeting producti ...
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Claims Examiner l
4 weeks ago
PrideStaff Folsom, United StatesJob: Claims Examiner Processor · Pay: $20-$26/hour · Location: Folsom, CA · Schedule: Mon-Fri (Business Hours) · Full Time-Direct Hire · Great Benefits, Including Medical, Dental, Vision, PTO, 401k & More..... · Pridestaff Financial currently in search for a Medical Claims ...
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Claims Examiner 1
16 hours ago
Insight Global Folsom, United StatesThe Claims Examiner I is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. · Additionally, processes claims by performing the following duties; Adjudicating medical claims, appling coordination of benefits as outlined in p ...
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Claims Examiner l
3 weeks ago
PrideStaff Folsom, United StatesJob: Claims Examiner Processor · Pay: $20-$26/hour · Location: Folsom, CA · Schedule: Mon-Fri (Business Hours) · Full Time-Direct Hire · Great Benefits, Including Medical, Dental, Vision, PTO, 401k & More..... · Pridestaff Financial currently in search for a Medical Claims ...
Medical Billing Specialist: Claims Examiner - Sacramento, United States - LHH Recruitment Solutions
Description
Job Description
Job DescriptionWe need to find a Claims Examiner in Sacramento, California This role is looking for longevity and dedication to joining the team, as well as a love for the industry. Are you skilled in claim adjudication, submissions, or claim reviews? This role plays an important role in working with the analysis and making sure payments are billed correctly and by contractual agreements. If this sounds like your passion, please apply today
Location: On-Site/Hybrid in Sacramento, CA
Pay: $18-20/hr
Hours: Full-Time, Monday-Friday
Job Description:
Qualifications: Any combination of education and experience that would likely provide the required knowledge and abilities is qualifying. A typical way to obtain the knowledge and abilities would be:
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.
Pay Details: $18.00 to $20.00 per hourSearch managed by: Jessica Roberts
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer/Veterans/Disabled
To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to
The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.
Medical Billing Specialist: Claims Examiner professionals in Sacramento
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MARCOS CORDOVA
Fluent in English, Spanish, and French