Job Summary: We are seeking a detail-oriented and experienced Medical Claims Examiner Processor to join our team in Folsom, CA. The ideal candidate will have extensive knowledge in adjudicating medical claims and coordinating benefits, ensuring accurate and timely payment determinations. This role requires excellent analytical skills, a strong understanding of medical coding, and the ability to effectively communicate with healthcare providers.

Responsibilities:

• Adjudicate medical claims and apply coordination of benefits as outlined in plan guidelines.
• Work with providers to gather necessary documents to make final payment determination on claims.

Skills Needed:

• Strong proficiency in ICD-10, CPT, and HCPCS codes.
• Excellent analytical and problem-solving skills.
• Effective communication skills, both written and verbal.
• Ability to work independently and manage time effectively.
• Proficiency in basic computer/Internet navigation and Outlook.
• Moderate experience with desktop applications.

Requirements:

• 3-5 years’ experience in the employee benefits industry.
• Background check and work references (Manager/Supervisor) required

Pre-Interview Tests: Candidates must take the following tests before meeting with the hiring manager. Results are required:

• Data/Typing (22 wpm or better)
• Basic computer/Internet navigation
• Outlook
• Desktop (Moderate experience or better)

Candidates will also need to take a Claims Examiner test on the day of their in-person interview with the hiring manager (if they reach that step).

Benefits:

• Medical, Dental, Vision: Eligibility is 30 days from start date.
• 401k: Matches 100% up to 3%, eligibility is 30 days from start date.
• 10 paid holidays.
• PTO: Accrue 120 hours in the first year.
• Sick time: 40 hours after working 90 days.