Job Openings in Sacramento County and Beyond

Claims Eligibility Specialist


Posted: 05/20/2024 Employment Type: Contract to Full Time Industry: Healthcare Job Number: 1677749

Job Description

We are recruiting for two Claims Eligibility Specialists for a thriving Independent Physician Association (IPA) based within the Greater Sacramento area. The Claims Eligibility Specialist supports the claims department and is responsible for verifying and confirming member eligibility, member enrollment, and notifying health plans when appropriate. These are onsite contract to hire opportunities and chance to gain great experience in the healthcare industry. Pay: $17-$18/hour DOE. 

The ideal candidate will have experience with medical claims and eligibility verification, high attention to detail and strong customer service skills. 


  • Verify member eligibility between eligibility uploads and add/update member profiles.

  • Confirm health plan enrollment by researching eligibility information online with various carriers and update systems with supporting documentation.

  • Research, investigate and resolve member eligibility discrepancies.

  • Document, coordinate and verify primary insurance carriers and/or other health coverage that members may have.

  • Identify inappropriately enrolled members upon new member enrollment and take necessary steps to correct their eligibility status (i.e. – appropriate aid codes, out-of-area, etc.)

  • Performs other related duties consistent with the scope and intent of the position.


  • 1+ year experience working with medical member eligibility experience.

  • High School diploma or equivalent required.

  • Microsoft Office Suite experience required.

  • Excellent communication skills, including both oral and written.

  • Ability to solve mid-level problems with minimal supervision.

  • Strong customer service skills.

  • Excellent attention to detail and ability to document information accurately, thoroughly, and effectively.

  • Must be able to accurately type 35 WMP.

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