Lead Claims Analyst - (Rancho Cordova, CA)

HourlyPosition Purpose: Assist in coordinating the day-to-day work function of the assigned claims unit, provide technical support to staff, and investigate, review and resolve complex issues + Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims + Oversee claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis + Assist in creating work flows for the department and support teammates in understanding changes in work processes + Primary contact for the team, for the plan and for other departments in researching, collecting experience info and documentation, to address various issues. + Assists supervisor to research and determine status of medical claims to assure billed dollars, claims aging, and pend values are consistent with contract provisions.