Claims Specialist

4 weeks ago

Costa Mesa, United States Hoag Memorial Hospital Presbyterian Full time

**Salary Range**: $19.8400 - $30.5000 /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education.
- The Claims Specialist (Customer Service) is responsible for answering phone calls from healthcare providers, health plans, billing companies, and members on inquiries related to claims, eligibility, and authorization. The Claims Specialist will ensure first-call-resolution standards are followed and will refer and follow-up as per Hoag Clinic MSO guidelines.- Essential Functions- Assist with resolving telephone calls from customers on inquiries related to claims, eligibility, authorization by accurately identifying customer needs and taking appropriate action
- Follow Hoag Clinic MSO guidelines and policies ensuring compliance with regulatory guidelines and health plan requirements
- Document all incoming calls following HIPAA guidelines in handling patient data
- Assist in identifying and reporting issues working with the Claims management team to help minimize re-work and address front-end process issues
- Interact in a positive and collaborative manner with internal and external partners especially in demanding and tense situations with providers and patients exhibiting a caring, empathetic, and patient attitude
- Support the claims team in implementing initiatives in improving claims processing efficiency
- Assist in provider customer service, member services, health plan, and other customers including making and answering phone calls to providers/billing offices when necessary based on team guidelines
- Perform other duties as assigned- Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives._

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