Medical Claims Examiner
3 weeks ago
ONSITE location: Sacramento, CA
Monday through Friday | 8am - 5pm
Pay will range between $20 - $26 (dependent on incoming experience)
Responsibilities:
- Submitting claims while following protocol and ensures audits are completed daily and reports are generated for all products.
- Properly adjudicate claims, respond to inquiries while conducing problem resolution techniques on service issues.
- Daily self-auditing and periodic auditing of submitted claims randomly to ensure quality.
- Ensure proper procedures are followed for adjudications and payments, coordination of benefits and final determination on claims.
- Verifying member benefits, conduct research for proper eligibility requirements.
- Monitor effective dates coincide appropriately with providers contract rates.
- Conducts needed research of data resources, audit results, trends, and root causes to issues.
- Ensuring amounts of refund letters are correctly processed and sent to providers.
- Maintains up to date knowledge of auditing policies and procedures.
- Collaborate and communicate with management teams, on audit findings.
Qualifications:
- REQUIRED – Minimum of 5 years of recent experience in full cycle Medical Claims Examination processing.
- High School Diploma or GED
- Knowledge of CPT, HCPCS, ICD-10 coding
- Knowledge of guidelines for Medical Billing and Payments
- Experience in Microsoft, Excel, Outlook, and Word
- Ability to effectively and efficiently multi-task
- Ability to work individually and collaboratively, with little supervision
- Highly detailed and sense of urgency
Pay Details: $20.00 to $26.00 per hour
Search managed by: Katherine Geanetta
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 https://www.lhh.com/us/en/candidate-privacy
The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
- The California Fair Chance Act
- Los Angeles City Fair Chance Ordinance
- Los Angeles County Fair Chance Ordinance for Employers
- San Francisco Fair Chance Ordinance
-
Medical Claims Examiner
3 months ago
Sacramento, United States Benefit & Risk Management Services, Inc. Full timeJob DescriptionJob 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 Duties and Responsibilities include the following. Other duties may be assigned.·...
-
Healthcare Claims Examiner
1 week ago
Sacramento, California, United States LHH Recruitment Solutions Full timeJob Overview:Sacramento, CA-based company LHH Recruitment Solutions is seeking a skilled Medical Claims Examiner to join their team. This full-time position involves processing medical claims while ensuring compliance with established protocols and audit procedures.Responsibilities:Submit claims accurately and efficiently while conducting daily audits to...
-
Claims Examiner Position
7 days ago
Sacramento, California, United States Command Investigations Full timeJob DescriptionAs a Claims Investigator at Command Investigations, you will play a critical role in helping us deliver exceptional service to our clients. Your primary responsibility will be to investigate claims thoroughly, gather evidence, and provide detailed reports.About the CompanyOur company values honesty, integrity, and self-reliance in our...
-
Claims Adjuster
4 weeks ago
Sacramento, United States TheBest Claims Solutions Full timeAbout The PositionTheBest Claims Solutions is seeking an experienced Claims Adjuster to handle complex CA Indemnity claims. As a direct hire opening, this position requires 3+ years of experience in claim handling, excellent communication and negotiation skills.Key Responsibilities:Conduct thorough investigations and manage litigation files within given...
-
Claims Examiner
1 month ago
Sacramento, California, United States Command Investigations Full timeJob OverviewWe are seeking experienced investigators with commercial or personal lines experience to join our team at Command Investigations.
-
Worker's Compensation Adjuster
4 weeks ago
Sacramento, United States TheBest Claims Solutions Full timeOur client, a National Insurance Carrier, is looking for a Workers Compensation Adjuster with 3+ years of experience for their remote Direct Hire Opening. Our client offers excellent health benefits, PTO, and year-end bonus.Scroll down for a complete overview of what this job will require Are you the right candidate for this opportunityRequired...
-
Senior Claims Investigator
6 days ago
Sacramento, California, United States Command Investigations Full timeJob SummaryWe are seeking a skilled Claims Investigator to join our team at Command Investigations. In this role, you will be responsible for conducting thorough investigations into various claims, gathering evidence, and providing detailed reports.About the CompanyAt Command Investigations, we value integrity, self-reliance, and resourcefulness in our...
-
Title Examiner
1 month ago
Sacramento, United States Lennar Full timeTitle Examiner We are Lennar Title Lennar Title is centered around personal growth, innovation, and diversity. We are looking for a new team member who shares our passion and dedication to bringing homeownership to life. At Lennar Title, you'll build your career with a Fortune 150 company that provides an excellent work environment, plenty of opportunities...
-
Nurse Practitioner, BEAR Forensic Examiner
5 days ago
Sacramento, United States Sutter Medical Group Full timeOpportunity InformationSutter Medical Group (SMG) seeks to hire a BEAR Forensic Examiner Nurse Practitioner to join our dynamic team in Sacramento, CA.This is a supplemental position – non–benefited.BRIDGING EVIDENCE ASSESSMENT AND RESOURCES (BEAR) PROGRAM EXAMINER The Bridging Evidence Assessment and Resources (BEAR) program is growing its elite team...
-
Nurse Practitioner, BEAR Forensic Examiner
3 days ago
Sacramento, United States Sutter Medical Group Full timeOpportunity InformationSutter Medical Group (SMG) seeks to hire a BEAR Forensic Examiner Nurse Practitioner to join our dynamic team in Sacramento, CA.This is a supplemental position – non–benefited.BRIDGING EVIDENCE ASSESSMENT AND RESOURCES (BEAR) PROGRAM EXAMINER The Bridging Evidence Assessment and Resources (BEAR) program is growing its elite team...
-
Nurse Practitioner, BEAR Forensic Examiner
4 days ago
Sacramento, United States Sutter Medical Group Full timeOpportunity Information Sutter Medical Group (SMG) seeks to hire a BEAR Forensic Examiner Nurse Practionter to join our dynamic team in Sacramento, CA.This is a supplemental position – non–benefited.BRIDGING EVIDENCE ASSESSMENT AND RESOURCES (BEAR) PROGRAM EXAMINER The Bridging Evidence Assessment and Resources (BEAR) program is growing its elite...
-
Sacramento, United States Sutter Medical Group Full timeOpportunity InformationSutter Medical Group (SMG) seeks to hire a BEAR Forensic Examiner Certified Nurse–Midwife to join our dynamic team in Sacramento, CA.This is a supplemental position – non–benefited.BRIDGING EVIDENCE ASSESSMENT AND RESOURCES (BEAR) PROGRAM EXAMINER The Bridging Evidence Assessment and Resources (BEAR) program is growing its...
-
Sacramento, United States Sutter Medical Group Full timeOpportunity Information Sutter Medical Group (SMG) seeks to hire a BEAR Forensic Examiner Certified Nurse–Midwife to join our dynamic team in Sacramento, CA.This is a supplemental position – non–benefited.BRIDGING EVIDENCE ASSESSMENT AND RESOURCES (BEAR) PROGRAM EXAMINER The Bridging Evidence Assessment and Resources (BEAR) program is growing its...
-
Sacramento, California, United States American Family Insurance Agency Staff Full timeAbout the RoleWe are seeking a skilled Claims Specialist to join our team at American Family Insurance Agency Staff. This is a challenging and rewarding role that requires expertise in investigating high-exposure property losses and ensuring timely resolution for our customers.Responsibilities:Conduct thorough investigations into complex claims, gathering...
-
BEAR Forensic Examiner
2 weeks ago
Sacramento, United States Sutter Health Sacramento Sierra Region Full timeSutter Medical Group (SMG) is seeking a BEAR Forensic Examiner NP to join our team in Sacramento, CA. Minimum 2+ years of clinical experience. This is a supplemental position. BRIDGING EVIDENCE ASSESSMENT AND RESOURCES (BEAR) PROGRAM EXAMINER The Bridging Evidence Assessment and Resources (BEAR) program is growing its elite team of highly trained forensic...
-
Medical Billing Specialist
1 month ago
Sacramento, United States Robert Half Full timeJob DescriptionJob DescriptionWe are offering a long term contract employment opportunity for a Medical Billing Specialist based in Sacramento, California, United States. In this role, you will be required to process medical claims, maintain confidentiality of patient records, and resolve billing discrepancies. Responsibilities:• Accurately process and...
-
Medical Practitioner
1 week ago
Sacramento, California, United States All Inclusive Medical Services Urgent Care, Inc Full timeJob OverviewAll Inclusive Medical Services Urgent Care, Inc is seeking a skilled Physician Assistant to join our team in an Urgent Care facility. This role requires extensive experience in Internal medicine.Key ResponsibilitiesDiagnose and treat various health conditionsConduct thorough examinations and provide medical care to patients aged two years and...
-
Medical Collections Specialist
2 months ago
Sacramento, United States Robert Half Full timeJob DescriptionJob DescriptionWe are in search of a diligent Medical Collections Specialist to join our team in Sacramento, California. In this role, you'll be responsible for managing medical collections and ensuring accurate record-keeping. This opportunity provides a contract to permanent employment option.Responsibilities:• Ensure accurate and...
-
Audiologist
3 weeks ago
Sacramento, United States Frontera Search Partners Full timeGeneral Summary of Position: Mon – Fri; 8am – 5pm Part Time/ 3 days/week; $72.12 per hour This position will review pertinent medical history documentation and provide one-time, non-treatment compensation and pension exams for Veterans. The Practitioner will capture responses during the exam through a web-based examination form; all documentation will...
-
Sacramento, California, United States Law Offices of Bradford & Barthel, LLP Full timeJob OverviewThe Law Offices of Bradford & Barthel, LLP seeks highly skilled workers' compensation defence attorneys to join our team in California, USA. As a remote/hybrid role, you can enjoy a flexible work environment with a competitive benefits package.We offer a premium salary and benefit package, with a salary range of $90,000-$200,000 based on skills,...