Claims Resolution Specialist

2 weeks ago

Orange, California, United States Cogent Infotech Corporation Full time
Job DescriptionJob Description

Description :
The client is seeking a highly motivated an experienced TEMP - Claims Resolution Specialist (Customer Service) to join our team. The Claims Resolution Specialist will be the first line of contact for the client's providers. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues.

Responsibilities :

  • 80% - Claims Support
  • Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or *** Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures.
  • Follows up with providers as needed.
  • 15% - Administrative Support
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Ensures accurate and timely documentation regarding all issues, and/or inquiries are entered in Facets.
  • Routes escalated calls to the appropriate departments and/or management.
  • 5% - Completes other duties or projects as assigned.


Minimum Qualifications :

  • High School diploma or equivalent required.
  • 2 years of experience in claims resolution required.
  • 1 year of call center experience with high call volumes or customer service experience required.
  • 1 year of HMO, Medi-Cal/Medicaid and healthcare/managed care experience required.
  • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.


Preferred Qualifications:
Required Licensure / Certifications:

Knowledge & Abilities :

  • Develop rapport and establish and maintain effective working relationships with *** Health's leadership and staff and external contacts at all levels and with diverse backgrounds
  • Work independently and exercise sound judgment.
  • Communicate clearly and concisely, both orally and in writing.
  • Work a flexible schedule; available to participate in evening and weekend events
  • Organize, be analytical, problem-solve and possess project management skills
  • Work in a fast-paced environment and in an efficient manner.
  • Manage multiple projects and identify opportunities for internal and external collaboration.
  • Motivate and lead multi-program teams and external committees/coalitions.
  • Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment


Physical Requirements (With or Without Accommodations) :

  • Ability to visually read information from computer screens, forms and other printed materials and information.
  • Ability to speak (enunciate) clearly in conversation and general communication.
  • Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
  • Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting
  • Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Company DescriptionAt Cogent, we are dedicated to pushing the boundaries of our expertise to set new industry standards. Through continuous refinement of our processes and broadening our services to meet evolving needs across industries, we provide effective, future-forward and comprehensive solutions.Company DescriptionAt Cogent, we are dedicated to pushing the boundaries of our expertise to set new industry standards. Through continuous refinement of our processes and broadening our services to meet evolving needs across industries, we provide effective, future-forward and comprehensive solutions.

  • Grievance Resolution Specialist X3

    2 weeks ago

    Orange, California, United States The Midtown Group Full time

    Department(s): Grievance & Appeals Resolution Services (GARS) Reports to: Manager, Grievance & Appeals Salary: $ $31.04 Duration: up to 6 months Job Summary The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member...

  • Claims Auditor

    4 weeks ago

    Orange, California, United States Prospect Medical Holdings, Inc. Full time

    The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and/or inquiry processing experience to audit and analyze simple to...

  • Employee Services Specialist

    2 weeks ago

    Orange, California, United States Orange Lutheran High School Full time

    POSITION SUMMARYThe Employee Services Specialist position is responsible for directing and planning the day-to-day operations of group benefits programs (group health, dental, vision, short-term and long-term disability, worker's compensation, life insurance, travel and accident plan, flexible spending plan, 401(k) plan and retirement plan). This position...

  • Clinical Development Specialist

    4 weeks ago

    Orange, California, United States Philips Full time

    Job TitleClinical Development SpecialistJob DescriptionClinical Development Specialist (Orange, OH)The Clinical Development Specialist creates and delivers innovative training programs in support of the Computed Tomography (CT) business within Precision Diagnosis—key in providing clinical input and expertise to the development teams and supporting customer...

  • Member Service Representative

    2 weeks ago

    Orange, California, United States Astiva Health, Inc Full time

    Job Title: Member Services Representative Target Compensation Range: $20.00-$28.00/hour, depending on the level of relevant qualifications and experience. About Us: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our...

  • TEMP - Grievance & Appeals Nurse Specialist

    2 weeks ago

    Orange, California, United States Cogent Infotech Corp Full time

    Job Description : The client is seeking a highly motivated an experienced TEMP - Grievance & Appeals Nurse Specialist to join the team. The Grievance and Appeals Nurse Specialist participates in managing the client's medical appeals and state hearing reviews for all lines of business, including handling expedited and standard requests. The incumbent will...

  • TEMP - Data Warehouse Reporting Analyst Sr

    2 weeks ago

    Orange, California, United States Equiliem Full time

    Client Summary- Single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health.Duties &...

  • Systems Support Specialist III, Neurology, ISD, Full Time

    2 weeks ago

    Orange, California, United States CHOC - Children's Health Orange County Full time

    Work LocationOrange, California Work ShiftDay - 08hrs (United States of America) Why CHOC? At CHOC, we strive to be the leading destination of children's health by providing exceptional and innovative care. We are responsible for the overall health of our community's pediatric population in our hospitals, clinics, and practices. And because of our breadth of...

  • EHS Specialist Ii

    2 weeks ago

    Orange, California, United States Nobel Biocare Full time

    Operating Company: Nobel BiocareLocation: Orange,CA,USDate Posted: June 12, 2024Req Number: R5019772Develops, implements and evaluates safety policies and procedures and may be involved in the compliance and ensurance of product EHS. Provides leadership and technical expertise in the development of strategies, programs and training to ensure compliance with...

  • Patient Finance Coordinator

    2 weeks ago

    Orange, California, United States Community Dental Partners Full time

    Financial Advisor/Treatment CoordinatorReports to: Practice ManagerKey Partnerships:Billing, Clinical, OperationsDepartment: OperationsSalary: $14-16/hr (based on experience)Classification: Non-ExemptStatus: Full TimeAbout this role:If you are team-oriented and looking for an opportunity to assist patients in our community, by providing a beautiful smile....

  • Claims Resolutions Specialist

    3 weeks ago

    Orange, United States The Midtown Group Full time

    Claims Resolutions Specialist Job Description Salary Grade: - $25.87 - $38.00/hr Job Summary The Claims Resolution Specialist will be the first line of contact for health providers. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues. Position Information: Department: Claims...

  • Claims Resolution Specialist

    3 weeks ago

    Orange, United States Ultimate Staffing Full time

    Claims Resolution Specialist (Customer Service) Orange, CA (On-Site) Schedule: 8am-5pm Salary: - $24/Hour The Claims Resolution Specialist will be the first line of contact for Health providers. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues. Duties & Responsibilities: 80% - Claims...

  • Claims Resolution Specialist

    4 weeks ago

    Orange, United States Cross Country Workforce Solutions Group Full time

    Job DescriptionJob DescriptionJob SummaryThe Claims Resolution Specialist is the first line of contact for providers. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues. Position ResponsibilitiesClaims SupportResponds and researches issues on provider questions regarding claims...

  • Claims Resolution Specialist

    4 weeks ago

    Orange, United States Cross Country Workforce Solutions Group Full time

    Job DescriptionJob DescriptionJob SummaryThe Claims Resolution Specialist is the first line of contact for providers. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues. Position ResponsibilitiesClaims SupportResponds and researches issues on provider questions regarding claims...

  • Claims Resolution Specialist

    4 weeks ago

    Orange, United States Cogent Infotech Corporation Full time

    Job DescriptionJob DescriptionDescription :The client is seeking a highly motivated an experienced TEMP - Claims Resolution Specialist (Customer Service) to join our team. The Claims Resolution Specialist will be the first line of contact for the client’s providers. The incumbent will assist providers with questions related to the payment of claims and...

  • Claims Resolution Specialist

    1 month ago

    Orange, United States Cogent Infotech Corporation Full time

    Job DescriptionJob DescriptionDescription :The client is seeking a highly motivated an experienced TEMP - Claims Resolution Specialist (Customer Service) to join our team. The Claims Resolution Specialist will be the first line of contact for the client’s providers. The incumbent will assist providers with questions related to the payment of claims and...

  • Claims Resolution Specialist

    4 weeks ago

    Orange, United States Infoway Solutions LLC Full time

    **Duties & Responsibilities**: **80% - Claims Support** - Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and...

  • Claims Resolution Specialist

    1 day ago

    Orange, United States Infoway Solutions LLC Full time

    **Duties & Responsibilities**: **80% - Claims Support** - Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and...

  • Grievance Resolution Specialist

    4 days ago

    Orange, United States Sumeru Inc Full time

    **Client: CalOptima Health** **Job Title: Grievance Resolution Specialist** **Duration: 06 Months** **Start Date: ASAP** **Location: 505 City Parkway West, CA (Onsite)** **Position Type: Contract** **Interview Type: In Person/Web Interview** **Ceipal ID: CAL_GAN531_BT** **Job Summary** CalOptima Health is seeking a highly motivated and experienced TEMP -...

  • Grievance Resolution Specialist

    4 weeks ago

    Orange, United States Infojini Full time

    Job Summary Seeking a highly motivated and experienced - Grievance Resolution Specialist to join our team. The Grievance Resolution Specialist will be responsible for coordinating the grievance and appeal resolution process. Will respond to verbal and written grievances and appeals from members and providers relating to member eligibility and benefits,...

  • Grievance Resolution Specialist

    4 weeks ago

    Orange, United States Infojini Full time

    Job Summary Seeking a highly motivated and experienced - Grievance Resolution Specialist to join our team. The Grievance Resolution Specialist will be responsible for coordinating the grievance and appeal resolution process. Will respond to verbal and written grievances and appeals from members and providers relating to member eligibility and benefits,...

  • Grievance Resolution Specialist

    1 month ago

    Orange, United States Cogent Infotech Corporation Full time

    Job DescriptionJob DescriptionJob title: Grievance Resolution SpecialistLocation:  Orange CA 92868Duration: 06 monthsJob Summary/ Essential Job Functions:The client is seeking a highly motivated and experienced  - Grievance Resolution Specialist to join our team. The Grievance Resolution Specialist will be responsible for coordinating the grievance and...

  • Claims Specialist

    4 days ago

    Orange, United States The Midtown Group Full time

    Job DescriptionJob DescriptionJob SummaryOne of our most prestigous healtcare clients is seeking a highly motivated an experienced TEMP - Claims Resolution Specialist (Customer Service) to join their team.The Claims Resolution Specialist will be the first line of contact for providers. The incumbent will assist providers with questions related to the...

  • Grievance Resolution Specialist

    4 days ago

    Orange, United States Infoway Solutions LLC Full time

    **Job Summary** The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process and responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions. The...

  • Grievance Resolution Specialist

    4 weeks ago

    Orange, United States VGroup Inc Full time

    Job DescriptionJob DescriptionClient: CalOptima HealthJob Title: Grievance Resolution SpecialistDuration: 06 MonthsStart Date: ASAPLocation: 505 City Parkway West, CA (Onsite)Position Type: ContractInterview Type: In Person/Web InterviewCeipal ID: CAL_GAN531_BTJob SummaryCalOptima Health is seeking a highly motivated and experienced TEMP - Grievance...

  • Claims Recovery Specialist

    2 weeks ago

    Orange, United States CalOptima Full time

    **Claims Recovery Specialist** **CalOptima** **CalOptima Health** is seeking a highly motivated an experienced **Claims Recovery Specialist** to join our team. The Claims Recovery Specialist will be responsible for performing recoveries on claims that have been overpaid and must understand and adhere to recovery regulations mandated by CalOptima Health...

  • Grievance Resolution Specialist

    3 weeks ago

    Orange, United States Equiliem Full time

    Client Summary: Our client is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health....

  • Grievance Resolution Specialist

    4 weeks ago

    Orange, United States Equiliem Full time

    Client Summary: Our client is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health....

  • Grievance Resolution Specialist

    4 weeks ago

    Orange, United States Equiliem Full time

    Client Summary: Our client is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health....

  • Grievance Resolution Specialist

    4 weeks ago

    Orange, United States Equiliem Full time

    Client Summary: Our client is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health....