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in Roseville, CA

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Hours Full-time, Part-time
Location Roseville, CA
Roseville, California

About this job

Position Overview:
Analyzes, reviews and processes medical, dental and prescription claims with the highest level of performance and quality for the participating members in the plans, in accordance with plan benefits, rules and guidelines. Responds to members, plan participants, claimants, service providers and insurance company inquiries and updates files based on information received.

Essential Duties and Responsibilities:

  • Prepares, analyzes, and adjusts claims for payment of services using current Plan rules and regulations.
  • Processes benefit claims by verifying accuracy of information, current eligibility under current plan design and calculating benefits.
  • Reviews claims and benefit requests for completeness and compiles necessary information from member files and other sources.
  • Researches and compiles information and documentation necessary for the completion and verification of benefit claims.
  • Determines whether member has additional coverage and coordinates claims processing with other carriers and TPA's, as necessary.
  • Initiates and prepares correspondence to members, beneficiaries, contributors, service providers and other parties to requests information needed to properly process a claim.
  • Performs data entry and data correction tasks within the computer system to update and correct claim information.
  • Determines and calculates any underpayments or overpayments. Using Plan rules and procedures, makes corrections and adjustments.
  • Utilizes available tools to establish appropriate guidelines for processing claims.
  • Complies with all HIPAA regulations and processes claims with the highest level of confidentiality.
  • Compiles and handles special projects as needed.
  • Assist Member Services as needed.

Qualifications:

  • 1+ year of Medical Claims Experience
  • Knowledge of Medical Terminology
  • Knowledge of CPT, ICD9 codes




About Aerotek:


Aerotek, headquartered in Hanover, Md., is a leading provider of technical, professional and industrial staffing services. Established in 1983, Aerotek is an operating company of Allegis Group, the largest provider of staffing services in the U.S. Aerotek operates a network of more than 200 non-franchised offices throughout the U.S., Canada and Europe. For more information, visit .

Aerotek is acting as an Employment Agency in relation to this vacancy.