Claims Examiner

LHH Recruitment Solutions is searching for a full-time Claims Examiner Representative on a contract to hire basis for a client in Sacramento, CA. This position is onsite and you must be located in Sacramento, CA!

This position calls for an individual who values stability and has a genuine desire to contribute to our organization's long-term success.

Compensation : $19-$22

Job Type : Contract to hire | Full Time | M-F

Responsibilities :

• Review and analyze claims to determine the appropriate payer based on coding, medical group service area, and contractual agreements outlined in the Division of Financial Responsibility (DoFR).
• Adjudicate claims in accordance with internal policies and regulatory guidelines to ensure accurate payment decisions.
• Process and adjust claim payments as needed, ensuring compliance with applicable policies.
• Handle member reimbursement claims while adhering to regulatory timeliness standards.
• Maintain consistent audit scores by ensuring accuracy and compliance with department quality standards.
• Route misdirected claims to the correct payer within 10 business days of receipt.
• Verify and acknowledge Western Health Advantage's risk claims within 15 business days of receipt.
• Process and finalize commercial claims for payment or denial within 45 business days.
• Ensure timely resolution of Employee Retirement Income Security Act (ERISA) claims within 30 days.
• Guarantee payment of clean claims within 30 calendar days of receipt.
• Process unclean and contracted claims within the required 60-day timeframe.
• Perform claims-related tasks with a high level of accuracy, efficiency, and adherence to productivity standards.

Qualifications :

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 : $19.00 to $22.00 per hour

Search managed by : Diana Bielawska

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

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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 :

Salary : $19 - $22