Job Openings in Sacramento County and Beyond
Claims Eligibility Specialist
Sacramento, CA 95831
- 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.
- Confirm covered benefits when member has OHC.
- Notify health plans when OCH is identified in order to better coordinate benefits.
- 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.
- Word processing and computer experience required.
- Microsoft Off Suite experience required.
- Ability to maintain production level and quality goals.
- Excellent communication skills, including both oral and written.
- Excellent active listening and critical thinking skills.
- Ability to solve mid-level problems with minimal supervision.
- Demonstrated excellence in organization.
Please apply or send your resume to liza@pacificstaffing.Com - Thank you!