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Claims Examiner II

2 months ago

Sacramento, California, United States Ultimate Staffing Full time
Job Summary

We are seeking a skilled Claims Examiner II to join our team at Ultimate Staffing. As a Claims Examiner II, you will be responsible for analyzing 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.

Key Responsibilities
  • Claims Analysis: Utilize knowledge of third party liability (TPL) process to prepare business correspondence, request second TPL letters, and scan documentation received regarding TPL.
  • Payment Determinations: Make claim payment determinations established by internal policy and regulatory agencies.
  • Claims Processing: Process claims, and make payment adjustments as necessary.
  • Member Reimbursement: Process member reimbursement claims.
  • Reporting and Compliance: Generate Claims reports as requested and consistently maintain department audit scores.

Requirements: Adhere to timeliness guidelines as established by regulatory agencies. Pay is up to $24.50 an hour. Ultimate Staffing is an equal opportunity employer and welcomes applications from all qualified candidates.