"Alerted.org

Description We are offering a short-term contract employment opportunity for a Medical Claims Processor in Rancho Cordova, California. This role operates within the healthcare industry, focusing on the careful review and processing of claims from Out of Group providers. As a Medical Claims Processor, you will determine the appropriateness of claims for payment based on various criteria and also ensure that denied claims are correctly recorded in the system.

Responsibilities:

• Review and process claims according to established policies and procedures

• Determine the eligibility, benefits, authorizations, coding, compliance, and contracted payment terms of claims

• Apply correct terms to claims as contracts change annually

• Ensure accurate denial of inappropriate claims in the system for correct letter printing

• Adhere to internal, external, and governmental timeliness standards consistently

• Pay or deny medical services using department policy guidelines

• Handle sensitive and confidential information appropriately

• Refer claims and documentation that do not meet department policy guidelines to the UM department as necessary

• Communicate with Eligibility, Member Services, UM, providers, the Health Plans, and applicable staff when required

• Maintain production and quality standards

• Work independently on assigned tasks and activities based on established policies and procedures. Requirements • Proficiency in Allscripts software is required for efficient workflow management.

• Experience with Cerner Technologies is essential to handle our specialized software needs.

• Familiarity with EHR SYSTEM is vital for effective handling of electronic health records.

• Expertise in appeals is crucial, as the role involves dealing with claim disputes.

• Understanding of billing functions is necessary to ensure accurate invoicing and payment processing.

• Prior experience in claim administration is required to manage and resolve health insurance claims effectively.

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.

All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

• 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .