We’re looking for a detail-oriented Claims Processing Specialist to support the review and processing of unique dental claims and related payment adjustments. This onsite opportunity in Rancho Cordova offers the chance to contribute to important claim resolution work in a collaborative, process-driven environment.

Responsibilities

• Review claims and supporting documentation to identify discrepancies between authorized treatment and submitted treatment.
• Process special claim payments and assist with VA CCN-related claim work.
• Handle returned checks, undeliverable checks, stale-dated checks, void requests, stop-payments, reissues, and related refund activity.
• Evaluate overpayments and underpayments, update claim status as needed, and support follow-up actions.
• Review monthly outstanding overpayment reports and coordinate with finance on special cases.
• Manage special professional reviews, service issues, and quality complaints in coordination with the appropriate internal team.
• Maintain accurate records, follow established procedures, and help improve existing workflows when opportunities arise.

Skills

• High school diploma or GED plus at least 2 years of relevant experience.
• Recent claims processing experience.
• Experience with dental claims processing, or medical/hospital claims processing, is strongly preferred.
• Strong attention to detail and accuracy in reviewing claims and documentation.
• Ability to work independently, prioritize tasks, and meet deadlines.
• Excellent analytical and critical thinking skills.
• Proficiency in Microsoft Excel.
• Customer service experience and the ability to respond professionally to inquiries and concerns.
• Basic understanding of claims adjudication and re-adjudication concepts.
• Familiarity with accounting principles, policies, procedures, and guidelines.

Preferred Skills

• Experience with special claims, overpayment handling, or payment reconciliation.
• Ability to collaborate effectively across teams and coordinate with finance or service support groups.
• Strong organizational skills with consistent follow-through.
• Comfort working through difficult situations and making timely decisions.
• Interest in process improvement and identifying better ways to support operations.

Horizontal Talent is committed to fostering a diverse, equitable, and inclusive workplace where all people are valued and respected. We welcome candidates from all backgrounds and encourage applications from individuals who can bring different perspectives, experiences, and strengths to the team.