Claims Processing Specialist

Claims Processing SpecialistLocation: Rancho Cordova, CA (onsite)Contract : 3+ Month (potential to extend)Work Schedule (Shift/Work Hours):6-2:30 or 7-3:30, M-F Job Description: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. ESSENTIAL DUTIESPerforms analysis of authorizations compared to submitted claims.Processes special claim payments, specifically for VA CCN client.Processes returned client 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.This list is not all-inclusive and you are expected to perform other duties as requested or assigned Skills/Experience: Minimum Qualifications2+ years of experience w/High School Diploma/GEDPrevious/recent experience in claims processingIdeal to have Dental Claims processing experienceHigh attention to detailSome customer service experience and claims adjudication experience including the understanding of re-adjudication is preferred.Additional ExperienceProficient in MS ExcelStrong 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 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 guidelinesIMPORTANT SKILLS:Attention to detail - takes time to review the claim, documents/notes, catch errors and process claims correctlyDental OR Medical/Hospital claims experiencePay Rate : $25-27/hr,W2