Job Description

The Claims Examiner I is responsible for adjudicating medical claims accurately and in a timely manner to ensure state regulations are met. The Claims Examiner I provides thorough review, analysis, and on-time adjudication of claim payment determinations, ensuring payments are billed at the correct contracted rate

• Make claim payment determinations established by internal policy and regulatory agencies
• Analyze claims for appropriate payer, based on combination of coding, medical group's service area, and contract per the Division of Financial Respons
• Process claims, and make payment adjustments as necessary.
• Process member reimbursement claims and adhere to timeliness guidelines as established by regulatory agencies.
• Consistently maintain the department audit scores.

$18-$20 an hour and ONSITE

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.

Job Snapshot

• Employee Type:Temp-to-Hire
• Location:Sacramento, CA
• Job Type:Health Care
• Experience:None
• Education:None
• Date Posted:4/11/2024
• Contact: Marley Canchola (916) 476-2393
• Pay Range: $18.00 - $20.00 Hourly

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