Senior Claims Examiner - (Rancho Cordova, CA)

HourlyPosition Purpose: The Senior Claims Examiner works under minimal supervision. Reviews and releases complex, high value claims for high profile complicated accounts, to determine type and amounts of benefits payable. Assists departmental management with evaluation of workflows and offers suggestions and ideas on methodology in an effort to reduce costs, increase production and maintain quality. Assists in the development of less experienced claims examiner through pre-payment claims review, releasing high dollar claims and inter-department auditing processes. Provides Claims Supervisor with assistance in monitoring production and quality through intermediate report methodology. Accurately processes high dollar, high risk and other complex claims eligible or ineligible for payment. Determines level of reimbursement based on established criteria, provider contract, plans and employer group provisions. Matches authorizations to claims and processes basic adjustments.