Appeals Examiner - West Sacramento, CA (On-site)

Summary

As Appeals Examiner - West Sacramento, CA (On-site), you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

• Review provider appeals using approved guidelines and documents appeal determinations clearly and concisely.
• Analyze, research and review appeal documentation to ensure all aspects of the appeal have been addressed properly and accurately while maintaining production goals and quality standards.
• Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation.
• Maintain performance within defined quality and quantitative objectives.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

What we're looking for

• Total of (2) years or more in medical claims and appeals experience required.
• Experience working with medical insurance and/or medical terminology required.
• Highly proficient with exceptional level of accuracy required.
• Ability to research and verify claim payment issues.
• Knowledge of Microsoft products (Outlook, Word, Excel and TEAMS).

What you should expect in this role

• This is an On-site/Office environment at West Sacramento, CA
• Hours are 6:00 a.m. – 2:30 p.m.

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