Job Summary:

The Claims Examiner I reviews and processes medical claims accurately and on time to meet internal policies and state regulations. This includes verifying proper coding, applying correct contract rates, and ensuring timely adjudication. This role is for a wonderful client based in Natomas, CA. This will be 100% on-site.

Key Responsibilities:

• Review and adjudicate claims based on policy, coding, and contractual guidelines

• Make payment or denial decisions in compliance with regulations

• Process adjustments, reimbursements, and misdirected claims within required timeframes

• Maintain audit standards and productivity goals

• Use Facets and other tools to ensure accurate, timely processing

• Complete other duties or special projects as assigned

Qualifications:

• High School Diploma required

• 1+ year of claims adjudication experience, preferably in an HMO setting

• Familiarity with ICD, CPT, and Revenue Codes

• Intermediate computer skills; Facets experience a plus

• Strong written and verbal communication