Our client, a leader in healthcare, is seeking a Claims Processing Specialist. This is an onsite role local to Rancho Cordova, CA. The hours for this role are 6:00AM – 2:30PM.

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

Contract Duration: 6 months (+ extensions)

Required skills and experience:

• 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

Daily Responsibilities:

• 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 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.
• Other duties as requested or assigned