Claims Processing Specialist / Contract / Onsite / Rancho Cordova, CA

Our client, a leading insurance provider and dental network, is seeking a Claims Processing Specialist. This is an onsite role in Rancho Cordova, CA.

The Claims Processing Specialist identifies and provides solutions for processing unique claims, refunds, overpayments, and underpayments. Other duties include processing special claims which may involve manual review of actual treatment compared to authorized treatment, and adjudicating VA CCN claims.

contract duration: 3 months (+ extensions)

Required skills and experience:

• 2+ years of experience w/High School Diploma/GED

• Previous/recent experience in claims processing - dental or medical/hospital claims

• Ideal to have dental claims processing experience

• High attention to detail

• Some customer service experience and claims adjudication experience including the understanding of re-adjudication is preferred.

• Proficient in MS Excel

• Strong analytical and critical thinking skills.

• Ability to maintain strict attention to detail.

• Excellent customer service skills with ability to evaluate and respond to the contact’s needs.

• Ability to independently prioritize work and establish, understand, and follow work rules and procedures, and take action to improve existing processes.

• Ability to confront difficult situations and make appropriate and timely decisions.

• Excellent organizational skills, including the ability to follow-up on commitments on a timely basis and adhere to deadlines.

• Ability to collaborate effectively with others.

• Basic knowledge of accounting principles.

• Knowledge of Enterprise policies, procedures, and guidelines


Daily Responsibilities:

Performs analysis of authorizations compared to submitted claims.

Processes special claim payments, specifically for VA CCN client.

Processes returned company checks, personal checks, undeliverable checks, stale dated checks, and requests for voids/stop-payments/re-issues.

Determines refund amounts, changes status of outstanding overpayments.

Reviews monthly reports for outstanding overpayments and coordinates with finance on special issues.

Reviews and handles special professional reviews and service issues, quality complaints and coordinates with Special Correspondence Unit.

other duties as requested or assigned

You will receive the following benefits:

• Medical Insurance - Four medical plans to choose from for you and your family
• Dental & Orthodontia Benefits
• Vision Benefits
• Health Savings Account (HSA)
• Health and Dependent Care Flexible Spending Accounts
• Voluntary Life Insurance, Long-Term & Short-Term Disability Insurance
• Hospital Indemnity Insurance
• 401(k) including match with pre and post-tax options
• Paid Sick Time Leave
• Legal and Identity Protection Plans
• Pre-tax Commuter Benefit
• 529 College Saver Plan

Motion Recruitment Partners (MRP) is an Equal Opportunity Employer. All applicants must be currently authorized to work on a full-time basis in the country for which they are applying, and no sponsorship is currently available. Employment is subject to the successful completion of a pre-employment screening. Accommodation will be provided in all parts of the hiring process as required under MRP’s Employment Accommodation policy. Applicants need to make their needs known in advance.