Job Openings in Sacramento County and Beyond

Claims Eligibility Specialist

Sacramento, CA 95831

Posted: 06/18/2021 Employment Type: Temp Industry: Healthcare Job Number: 1543843

Job Description

Pacific Staffing is hiring a Claims Eligibility Specialist to work with a large healthcare organization in Sacramento.   The Eligibility Specialist's primary role is to verify and confirm member eligibility and notifying health plans when appropriate.   This is a full-time position that is temporary to hire.  

Job Functions:

  • 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!

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