Position Overview
Description We are looking for a Medical Claims Representative to join our team in Pleasanton, California in a Contract to Permanent role. This position is ideal for someone with experience handling medical claims, billing activity, and insurance-related documentation in a fast-paced environment. The person in this role will support accurate claim review and member-related processing while communicating clearly with Spanish-speaking members and internal teams. Success in this position requires strong knowledge of medical terminology, benefit plans, and claims administration procedures.
Responsibilities:
β’ Review, evaluate, and process medical claims with close attention to accuracy, completeness, and applicable coverage details.
β’ Enter and maintain member, enrollment, beneficiary, and medical information within internal claims systems while following established procedures.
β’ Verify insurance details and confirm benefit eligibility to support timely and correct claim...