Claims Specialist
3 weeks ago
Every 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 centers, emergency shelters, housing services and children's and family programs. IF currently has 13+ facilities with 22+ micro-communities scattered across Orange County, Los Angeles County and the Inland Empire. Job Description The role of a Billing Claims Specialist involves overseeing the billing process for customers or patients, processing payments, maintaining financial records, and ensuring accurate billing and claims submissions. In addition, the Claims specialist is also responsible for keeping account receivables for CalAIM current, claim follow-up and escalation, and must have knowledge of billing codes and standard procedures. The pay rate for this role is $25-$27 per hour. The schedule for this role is a hybrid schedule with Monday/Thursday in office and Tuesday/Wednesday/Friday WFH. Responsibilities: CalAIM Billing and Follow up Reviewing data and creating Claims for services rendered Ensure claims meet the standards of our contracts and programs. Verifying authorizations via provider portals or authorization letters on Kipu prior to claim submission. Verifying eligibility prior to claim submission via provider or DHCS portals Review client records to extract applicable data necessary for billing purposes, including but limited to ICD 10 Diagnosis codes, CPT codes for services rendered etc. Review and follow up on outstanding account receivables Review any rejected or denied claims and conduct proper follow up procedures (Escalations/Appeals/Claim corrections) Monitor and maintain county aging and escalating trends, write offs, etc. Have knowledge in understanding, reading EOB’s and Remittance Advice Posting payment accurately to claims and continuing with the claim close out process Assist supervisors in any projects related to billing that may come up Attend monthly team meetings or trainings at Corporate location Expectations: Communicate with tact and professionalism Be able to meet targets and work under pressure with a high volume of claims Maintain knowledge of industry standard CMS guidelines for Billing Must be motivated to work independently as well as in a group setting. Minimum Qualifications/Preferred Experience: High School Diploma or equivalent. 1-2 years' relevant experience. Basic computer skills, including the ability to send and receive emails and summarize data in spreadsheets. Prior experience work in Electronic Billing Platforms and EHR systems Prior experience working with claims and communication with health networks Proficiency in Microsoft (Mail, Word, Excel, Calendar). Associate's degree or higher Medical Billing Certificate Experience in Medical Billing and Primary Care Billing Benefits Medical Insurance funded up to 91% by Illumination Health + Home (Kaiser and Blue Shield), depending on the plan Dental and Vision Insurance Life, AD&D and LTD Insurance funded 100% by Illumination Health + Home Employee Assistance Program Professional Development Reimbursement 401K with Company Matching 10 days vacation PTO/year 6 days of sick pay/year Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans Powered by JazzHR
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Claims Specialist
4 weeks ago
Santa Ana, United States Illumination Foundation Full timeBilling Claims SpecialistEvery 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...
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Sr. Claims Specialist
4 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
1 week 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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Senior Claim Adjuster
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Santa Ana, United States Davies Full timeSenior Claim AdjusterImagine being part of a team that's not just shaping the future but actively driving it. At Davies North America, we're at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and...
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Claim Specialist
2 days ago
Santa Barbara, California, United States State Farm Full time $64,965 - $104,056OverviewBeing good neighbors – helping people, investing in our communities, and making the world a better place – is who we are at State Farm. It is at the core of how we operate and the reason for our success. Come join a #1 team and do some goodGrow Your Skills, Grow Your PotentialResponsibilitiesJoin our team as a Property Field Inspection Claim...
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Marine Claims Senior Claims Specialist
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Santa Fe, NM, United States Zurich NA Full timeMarine Claims Senior Claims Specialist 126574 Zurich North America is hiring a Marine Claims Senior Claims Specialist Role (With Hull and Liability experience preferred) to join our team! We are open to remote work for the right candidate located within the U.S.. In this role you will be responsible for: Ability to handle dedicated accounts. Frequent...
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Claim Specialist
1 week ago
Santa Barbara, CA, United States State Farm Mutual Automobile Insurance Company Full timeLocation US-CA-Santa Barbara Job Category Claims and Investigation Position Type Regular Full Time Req ID 42798 Overview Being good neighbors – helping people, investing in our communities, and making the world a better place – is who we are at State Farm. It is at the core of how we operate and the reason for our success. Come join a 1 team and do some...
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Remote Field Based Property Claims Specialist
3 weeks ago
Santa Barbara, CA, United States State Farm Full timeLocation US-CA-Santa Barbara Job Category Claims and Investigation Position Type Regular Full Time Req ID 42798 Overview Being good neighbors - helping people, investing in our communities, and making the world a better place - is who we are at State Farm. Responsibilities Join our team as a Property Field Inspection Claim Specialist and showcase your...
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Sr. Claims Specialist
2 days 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
3 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...
