Claims Resolution Specialist

3 days ago

Orange, United States Equiliem Full time

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. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues.

Position Information:
Department: Claims Administration
Duties & Responsibilities:

  • Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or 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.
  • 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.
  • 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
Equiliem Healthcare specializes in staffing clinical, non-clinical, and allied personnel. We excel in all levels, disciplines, and specialties within the healthcare spectrum. Our projects range from short to long term local and travel assignments. Equiliem has been recognized as a certified small business enterprise. In addition, we are proud that we have earned the prestigious Joint Commission accreditation for staffing firms and have been awarded Best in Staffing 4 years running by our employees and client partners.

Benefits offered to our workers include the following:
  • Medical Insurance
  • Vision & Dental insurance
  • Life Insurance
  • 401K
  • Commuter Benefits
  • Employee Discounts & Rewards
  • Payroll Payment Options

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