Claims Contract Specialist

**Position Summary**:
Provides support in the ongoing maintenance and configuration of Regal Medical Group systems, including but not limited to the data entry of Contracting Database, Providers, Vendors, Fee schedules, Capitation Configuration. Performs system maintenance functions in a manner that is responsive to customer needs and support Regal initiatives.

**Essential Duties and Responsibilities include the following**:

- Adheres to Data integrity policies for all system configurations.
- Responsible for the accurate and timely completion of tasks assigned.
- Performs random audits as required to support policies and procedures for data integrity.
- Communicates with management and makes recommendations to improve processes.
- Ensure all systems within their area of responsibility are reliable, responsive and support to the needs of the Medical Group networks.
- Maintains a customer satisfaction focused, service mentality to strengthen and build relationships with Heritage Provider Network and all Medical Groups under HPN.
- Attends administrative meetings as requested.
- Process a minimum of 60 provider adds daily.
- Performs other duties as necessary.
- All other duties as directed by management.

**Education and / or Experience**:

- 3-5 years of HMO Claims Adjudication experience (Professional & Institutional).
- Experience with EZ-Cap configuration and operation.
- Ability to review and interpret Vendor contract language.
- Industry experience and knowledge of Industry standard Fee schedules and timing of standard fee schedule updates.
- Ability to understand system configuration implications on UM and Claims processes.
- 2 years of Claims experience preferred.
- Excellent written and verbal communication skills.

The pay range for this position at commencement of employment is expected to be between ; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

**Full Application**:
Pay: $22.00 - $27.00 per hour

**Benefits**:

- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance

Schedule:

- 8 hour shift
- Day shift
- Monday to Friday

Work setting:

- Hybrid work

People with a criminal record are encouraged to apply

Ability to Relocate:

- Northridge, CA 91325: Relocate before starting work (required)

Work Location: Hybrid remote in Northridge, CA 91325