Claims Specialist
3 weeks ago
Overview To support the Claims Department in maintaining pended claims and claim adjustments within established guidelines. Reviews and processes complex claims, and supports claims examining. Responsibilities Researches and processes claim adjustment requests. Participates in special claim adjustment projects as assigned. Assists in maintaining pended claim reports and files within established department guidelines and program policies. Performs claims examining functions as assigned. Performs claims customer service functions as assigned. Assists in training claims staff as needed. Monitors efficiency of operations and provides feedback to management on possible effective procedure changes. Records daily production statistics and related activities on appropriate reports; turns all logs and reports into the Claims Supervisor. Other duties as assigned. Qualifications Education and Experience Minimum three (3) years claims examining experience; or Partnership claims examining experience and completion of Parttnership claims training; or equivalent combination of education and experience; College course work in business or related field preferred. Special Skills, Licenses and Certifications Familiarity with Medi-Cal and/or managed care claims processing. Knowledge of CPT, HCPC procedure coding, and ICD-9 diagnostic coding. Knowledge of Partnership Claim Policy and Procedures, EDS provider manual guidelines, Title 22 regulations and any other required policies, procedures, regulations, and manuals. Typing speed 30 wpm and proficient use of 10-key calculator. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business. Performance Based Competencies Excellent oral and written communication skills. Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy. Ability to work on multiple tasks within established time frames and sometimes with conflicting priorities. Good organizational skills with ability to maintain accurate records and documentation of actions and decisions. Work Environment And Physical Demands Ability to use a computer keyboard; more than 80% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying sizes, weighing up to 25 lbs. Ability to attend off-site meetings as required. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees Maintain safe practices; and Abide by the HealthPlan's policies and procedures, as they may from time to time be updated. HIRING RANGE: $34.79 - $43.48 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
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Claims Specialist
2 weeks ago
Fairfield, CA, United States Partnership HealthPlan of California Full timeOverview To support the Claims Department in maintaining pended claims and claim adjustments within established guidelines. Reviews and processes complex claims, and supports claims examining. ResponsibilitiesResearches and processes claim adjustment requests. Participates in special claim adjustment projects as assigned. Assists in maintaining pended claim...
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Sr. Claims Specialist
3 days ago
Orange, CA, United States Cooperative of American Physicians, Inc. Full timeCAP seeks a Senior Claims Specialist for its Orange County office. This role involves handling technical and administrative duties to manage assigned claim files; assumes increased workload of highly complex claims. The Senior Claims Specialist also plays an active role in the ongoing training and oversight of Claims Specialist I and II team members. Our...
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Sr. Claims Specialist
7 days ago
Orange, CA, United States Cooperative of American Physicians, Inc. Full timeCAP seeks a Senior Claims Specialist for its Orange County office. This role involves handling technical and administrative duties to manage assigned claim files; assumes increased workload of highly complex claims. The Senior Claims Specialist also plays an active role in the ongoing training and oversight of Claims Specialist I and II team members. All the...
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Claims Specialist
3 weeks ago
Santa Ana, CA, United States Illumination Foundation Full timeEvery person deserves compassion, dignity, and the safety of a place to call home.” Homelessness is the largest social and public health crisis in California. Illumination health + home is a growing non-profit organization dedicated towards disrupting the cycle of homelessness by providing targeted, interdisciplinary services in our recuperative care...
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Automotive Claims Specialist I
2 weeks ago
Fairfield, NJ, United States Cox Full timeAt Manheim (a Cox Automotive company), we strive to make sure every customer is completely satisfied when they do business with us. On the off-chance we fall short, we do our best to make things right, pronto. We're looking for an Auto Claims Specialist I to learn the ropes of resolving customer complaints and ensuring we don't make the same mistake again....
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Claims Medi-Cal Supervisor
2 weeks ago
Fairfield, CA, United States Partnership HealthPlan of California Full timeOverview To supervise the Medi-Cal Claims Specialists and Examiners. Ensures delivery of highest level of customer service to the community and its medical providers. ResponsibilitiesSupervises the Medi-Cal claims specialists and examining staff. Daily supervision of the claims workflow. Supports claim examining and specialist functions. Maintains claim...
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Claims Medi-Cal Supervisor
2 weeks ago
Fairfield, CA, United States Partnership HealthPlan of California Full timeOverview To supervise the Medi-Cal Claims Specialists and Examiners. Ensures delivery of highest level of customer service to the community and its medical providers. ResponsibilitiesSupervises the Medi-Cal claims specialists and examining staff. Daily supervision of the claims workflow. Supports claim examining and specialist functions. Maintains claim...
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Sr. Claims Specialist
14 hours ago
Orange County, CA, United States Cooperative of American Physicians, Inc. Full timeCAP seeks a Senior Claims Specialist for its Orange County office. This role involves handling technical and administrative duties to manage assigned claim files; assumes increased workload of highly complex claims. The Senior Claims Specialist also plays an active role in the ongoing training and oversight of Claims Specialist I and II team members. Our...
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Senior Reimbursement Specialist
2 weeks ago
Burlingame, CA, United States North East Medical Services Full timeThe MSO department seeks a PDR Specialist with strong verbal and written communication skills to handle provider disputes and appeals related to claims payments. This role involves researching, evaluating, and resolving claims disputes in line with regulations, policies, and industry standards. The specialist will also conduct root cause analyses, process...
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Workers Comp Claims Oversight Specialist
7 days ago
Rancho Cordova, CA, United States Samuel Hale Full timeJoin Our Dynamic Team as a Workers' Comp Claims Oversight Specialist! Position: Claims Oversight Specialist Location: In-Office, Rancho Cordova, CA 95670 Job Type: Full-time Exempt Who We Are: EmployInsure LLC delivers Engineered Employment Products designed to eliminate gaps from antiquated practices and enable Frictionless Employment for...
