Claims Examiner II at Roth Staffing Companies in Sacramento, California

Job Description:

-Analyze claims for appropriate payer based on combination of coding, medical group's service area, and contract per the Division of Financial Responsibility (DoFR) document.
- Utilize knowledge of third party liability (TPL) process to prepare business correspondence, request second TPL letters, and scan documentation received regarding TPL.
- Make claim payment determinations established by internal policy and regulatory agencies.
- Process claims, and make payment adjustments as necessary.
- Process member reimbursement claims.
- Adhere to timeliness guidelines as established by regulatory agencies.
- Generate Claims reports as requested.
- Consistently maintain department audit scores.


Pay is up to $24.50 an hour


All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. To the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.