Claims Resolution Specialist
2 weeks ago
We are seeking a highly skilled Claims Customer Service Representative I to join our team at Partnership HealthPlan of California. In this role, you will be responsible for researching and resolving provider telephone and written inquiries, accurately screening claims, and participating in provider meetings and projects.
Key Responsibilities- Respond to provider inquiries, research policy issues, and analyze EOP's and claim history to recommend and implement resolutions.
- Communicate outcomes to providers of CIF's, claim tracers, and general claim correspondence within established time frames.
- Follow established PHC policies and procedures, PHC claims operating instruction memorandums, EDS provider manual guidelines, and Title 22 regulations when resolving claims and claim issues.
- Participate in provider meetings to resolve claim issues and recognize opportunities for process improvements.
- Record daily production statistics and related activities on appropriate reports and meet established production and call performance metrics.
- Participate in special projects and assignments as required and contribute to the resolution of CIFs.
- High school diploma or equivalent; one (1) year of prior claims processing experience in an automated claim environment preferred.
- Knowledge of CPT, HCPC procedure coding, and ICD-10 diagnostic coding, as well as medical terminology.
- Excellent written and oral communication skills, with the ability to exercise good judgment and handle sensitive issues with tact and diplomacy.
- Good organizational skills and ability to accurately complete tasks within established time frames.
Ability to use a computer keyboard and spend more than 80% of work time in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size weighing up to 25 lbs.
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 HealthPlans policies and procedures.
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Employment Law Specialist
2 weeks ago
Fairfield, California, United States Essel Full time{"h1": "Employment Law Specialist", "p": "At Essel, we are seeking a highly skilled Employment Law Specialist to join our team. As an Employment Law Specialist, you will play a crucial role in managing and defending against employment claims, particularly focusing on frivolous PAGA lawsuits. Your expertise will be essential in leading legal strategies,...
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Complex Property Claims Specialist
6 days ago
Fairfield, California, United States Cincinnati Financial Full timeWe're seeking an experienced property claims professional to remotely handle complex property claims nationwide.Key Responsibilities:Investigate and adjust large and complex property claims in the United StatesAnalyze property coverage formsResolve questions of coverage and value of claimsPrepare and/or evaluate estimatesAssist in catastrophe...
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In-House Employment Attorney
2 weeks ago
Fairfield, California, United States Essel Full timeEmployment Litigation AttorneyWe are seeking a seasoned Employment Litigation Attorney to join our team at Essel. The ideal candidate will have a strong background in employment law and a proven track record of managing complex employment-related litigation.Develop and implement effective legal strategies to defend against employment claims and...
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Eligibility Benefits Specialist III
3 weeks ago
Fairfield, California, United States Solano County Full timeJob SummaryThe Eligibility Benefits Specialist III is a lead and advanced working level position in the Eligibility Worker series. This role assists the unit supervisor in overseeing and guiding the work of unit staff, performing complex assignments, and providing technical expertise and support in multi-programs to staff.Key ResponsibilitiesLead work,...
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Equal Employment Specialist
5 days ago
Fairfield, California, United States Internal Revenue Service Full timeJob SummaryThe Internal Revenue Service (IRS) is seeking a highly skilled Equal Employment Specialist to join our team. As an Equal Employment Specialist, you will play a critical role in promoting a culture of inclusion and diversity within the IRS. You will be responsible for developing and implementing EEO programs, providing training and guidance to...
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Equal Employment Specialist
2 weeks ago
Fairfield, California, United States Internal Revenue Service Full timeJob Summary The Internal Revenue Service (IRS) is seeking a highly skilled Equal Employment Specialist to join our team. As an Equal Employment Specialist, you will play a critical role in promoting a culture of inclusion and diversity within the IRS. You will be responsible for providing technical support and assistance to employees and management officials...
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Quality Assurance Specialist
4 weeks ago
Fairfield, California, United States Patco Brands Full timeQuality Coordinator Job DescriptionAt Patco Brands, we are seeking a highly skilled Quality Coordinator to join our team. As a Quality Coordinator, you will play a critical role in ensuring the quality of our products and services.Responsibilities:Assess the quality of incoming materials, labels, and finished goods to ensure they meet specifications and...
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Customer Service Representative
2 months ago
Fairfield, California, United States Partnership HealthPlan of California Full timeJob SummaryWe are seeking a highly skilled and compassionate Customer Service Representative to join our team at Partnership HealthPlan of California. As a key member of our Member Services department, you will be responsible for providing exceptional customer service to our members, resolving issues, and ensuring their overall satisfaction with our...
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Military Support Specialist
6 days ago
Fairfield, California, United States Triwest Healthcare Full timeJob SummaryThis position resides within the Military & Veteran Services (MVS) division and is assigned to support the internal staff of military treatment facilities (MTFs).The incumbent will also work closely with MTF staff to support TRICARE beneficiaries and provide non-clinical support for patient referrals and authorizations; outreach to network...
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Landscape Maintenance Specialist
2 weeks ago
Fairfield, California, United States Monarch Landscape Companies Defunct Full timeMonarch Landscape Companies is a leading provider of landscape services in the United States. We are committed to delivering exceptional results and fostering a positive work environment. Our team is dedicated to maintaining the highest standards of quality and safety in all aspects of our operations. **Essential Responsibilities:**• Maintain company...
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Customer Relations Specialist
6 days ago
Fairfield, California, United States Annette Snowden Full timePosition Overview:We are seeking a highly motivated and customer-focused individual to join our team as a Customer Relations Representative. As a key member of our team, you will be responsible for forging enduring customer relationships and proactively following up to ensure continued satisfaction.Responsibilities:Employ a customer-centric, needs-based...
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Enterprise Network Support Specialist
2 months ago
Fairfield, California, United States Zantech Full timeAbout ZantechZantech is a dynamic small business that provides complex, mission-focused solutions to federal clients. We are committed to delivering outstanding performance and building long-term relationships with our clients and employees.Job SummaryWe are seeking a highly skilled Citrix Admin to provide complete network support and system infrastructure...
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Telecom Systems Specialist
1 month ago
Fairfield, California, United States Avenu Insights & Analytics Full timeJob Title: Telecom TechnicianJob Summary:The Telecom Technician will be responsible for supporting and maintaining the Cisco VoIP Telephone System (CUCM version 12.x), Cisco UCCX (Call Center), and Unity (Voicemail System). This role involves handling user requests, troubleshooting phone issues, managing IVR scripts, and maintaining telecommunication...
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Telecom/Cisco VoIP Systems Specialist
2 weeks ago
Fairfield, California, United States Avenu Insights & Analytics Full timeJob OverviewAvenu Insights & Analytics is seeking a highly skilled Telecom/Cisco VoIP Technician to join our team. The ideal candidate will have hands-on experience with Cisco systems and a strong understanding of telecommunication protocols and equipment.Key Responsibilities:Manage and maintain the Cisco VoIP Telephone System (CUCM version 12.x), including...
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Radiologic Imaging Specialist
6 days ago
Fairfield, California, United States Bon Secours Mercy Health Full timeAbout the Role:We are seeking a skilled Radiologic Technologist to join our team at Bon Secours Mercy Health. As a Radiologic Technologist, you will play a critical role in providing high-quality patient care and contributing to the success of our diagnostic imaging department.Key Responsibilities:Obtain patient clinical history and lab work, ensuring...
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Revenue Cycle Specialist
2 weeks ago
Fairfield, New Jersey, United States Infucare Rx Inc on behalf of itself and its subsidiaries Full timeJob SummaryAs a Revenue Cycle Specialist at InfuCare Rx Inc on behalf of itself and its subsidiaries, you will play a crucial role in ensuring accurate payment for our patients. Your expertise in investigating irregularities and resolving problems will be invaluable in this position.Key Responsibilities:Research and resolve claim denials and payment...
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Revenue Cycle Specialist
1 week ago
Fairfield, New Jersey, United States Infucare Rx Inc on behalf of itself and its subsidiaries Full timeJob Title: Revenue Cycle SpecialistInfuCare Rx is a leading home infusion provider accredited by URAC and ACHC, offering a specialized approach to caring for patients in need of IV therapy and specialty pharmacy services in the homecare setting.We have created an ethical, team-oriented, and quality work environment for our employees that cultivates...
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Revenue Cycle Specialist
2 weeks ago
Fairfield, New Jersey, United States Infucare Rx Inc on behalf of itself and its subsidiaries Full timeJob Title: Revenue Cycle SpecialistInfuCare Rx Inc on behalf of itself and its subsidiaries is seeking a skilled Revenue Cycle Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for managing the reimbursement process for our infusion pharmacy services.Key Responsibilities:Prepare and submit clean claims to...
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Revenue Cycle Specialist
2 weeks ago
Fairfield, New Jersey, United States Infucare Rx Inc on behalf of itself and its subsidiaries Full timeJob DescriptionAt InfuCare Rx, we're dedicated to providing innovative, progressive care to patients in need of IV therapy and specialty pharmacy services in the homecare setting. Our team-oriented and quality-driven work environment cultivates achievement and success.We're seeking a skilled Revenue Cycle Specialist to join our team. As a key member of our...
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Help Desk Specialist
4 weeks ago
Fairfield, Ohio, United States Insight Global Full timeHelp Desk Specialist Job DescriptionInsight Global is seeking a skilled Help Desk Specialist to provide exceptional onsite support for our clients. As a Help Desk Specialist, you will be responsible for delivering outstanding technical support to our clients, ensuring their IT needs are met with efficiency and professionalism.Key Responsibilities:Provide...
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Reimbursement Specialist
2 weeks ago
Fairfield, New Jersey, United States Infucare Rx Inc on behalf of itself and its subsidiaries Full timeJob SummaryAs a Reimbursement Collector at InfuCare Rx, you will play a critical role in ensuring accurate payment for our patients. Your responsibilities will include researching claim denials, following up on outstanding claims, and preparing appeals to ensure timely payment.Key Responsibilities:Investigate and resolve claim denials and payment...
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Part-time Help Desk Specialist
4 days ago
Fairfield, United States Insight Global Full timeJob DescriptionJob DescriptionInsight Global is looking for a Help Desk Specialist in the Fairfield, OH area! Below is more information of what we are looking for in candidates and what to expect on a day to day in the role:Desired Skills & Experience:2+ Years of experience in a help desk roleExperience with handling tier 1 and 2 tickets in a Microsoft...
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Insurance Customer Service Representative
2 weeks ago
Fairfield, Texas, United States State Farm Insurance Full timeJob Title: Office RepresentativeState Farm Insurance is seeking a highly skilled and customer-focused Office Representative to join our team. As an Office Representative, you will play a critical role in providing exceptional customer service, processing insurance policy changes and updates, and handling incoming and outgoing phone calls.Key...
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HR & Benefits Specialist
2 weeks ago
Fairfield, New Jersey, United States DLA Full timeJob SummaryWe are seeking a highly skilled and experienced HR & Benefits Specialist to join our team at DLA. As a key member of our HR department, you will be responsible for supporting the HR team in all aspects of human resources, with a specific focus on onboarding and benefits administration.Key ResponsibilitiesAdminister employee benefits programs,...
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Customer Care Specialist II
2 months ago
Fairfield, New Jersey, United States Legrand AV, Inc. Full timeJob SummaryWe are seeking a highly skilled Customer Care Specialist II to join our team at Legrand AV, Inc. This role is responsible for providing exceptional customer service and support to our clients, ensuring their needs are met and exceeded.Key ResponsibilitiesProvide daily support and guidance to team members on the proper execution of common support...
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Radiologic Technologist
1 week ago
Fairfield, Ohio, United States Bon Secours Mercy Health Full timeJob Title: Radiologic Technologist - Electrophysiology SpecialistAt Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety, and cost-effectiveness. Our hospitals, care sites, and clinicians are recognized for clinical and operational excellence.Job SummaryThe Radiologic Technologist - Electrophysiology Specialist will...
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Seasonal Mental Health Specialist
2 weeks ago
Fairfield, New Jersey, United States JCC Association Full timeJob Title: Seasonal Mental Health ProfessionalRound Lake Camp, a unique inclusion model at NJY Camps, seeks a Seasonal Mental Health Professional to join our support team. As a key member of our team, you will work closely with the Camp Director and other staff to provide emotional support and guidance to our campers.Responsibilities:Collaborate with...
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HR Support Specialist
1 month ago
Fairfield, Ohio, United States Beneficial Talent Source Full timeHR Assistant OpportunityBeneficial Talent Source is seeking a highly skilled HR Assistant to support our Fairfield Ohio distribution center during a short-term assignment. This role is a great opportunity to gain experience in human resources and contribute to a dynamic team.Key Responsibilities:Assist in researching, developing, and administering training...
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Safety Manager
2 weeks ago
Fairfield, United States DMW&H Full timeAbout Us:DMW&H is a premier Automated Material Handling Systems Integrator headquartered in Northern NJ. Our employees have recognized us as one of the best places to work in New Jersey for eight continuous years. As a leading automation company, DMW&H specializes in the design, integration, installation, and support of innovative distribution centers...
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Customer Service Rep CAC
1 week ago
Fairfield, United States Sentara Healthcare Full timeSentara is hiring a Customer Service Representative for the Clinical Access Centralized Scheduling Department. Minimum Requirements: High School Diploma or equivalent Two years of Customer Service experience. Experience with medical insurance in a hospital or physician's office setting preferred High Volume call center experience preferred Epic EMR...
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Labor & Employment Attorney
15 hours ago
Fairfield, United States gpac Full timeJob Description A law firm, serving clients throughout Georgia, Alabama, and the Southeast, is seeking a motivated and experienced Litigation Attorney to join our growing team. With a deep commitment to advocating for employee rights, they focus on labor law, ERISA, and multi-employer benefit plans. The firm also represents individuals in a wide range of...
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Application Support Specialist
2 weeks ago
Fairfield, New Jersey, United States Infucare Rx Inc on behalf of itself and its subsidiaries Full timeJob SummaryInfuCare Rx Inc is seeking a skilled Application Support Engineer to provide technical assistance for our suite of applications. This role involves troubleshooting, diagnosing, and resolving application issues, as well as ensuring seamless functionality for internal and external users.Key ResponsibilitiesApplication Support: Provide front-line...
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HR Support Specialist
4 weeks ago
Fairfield, Ohio, United States Rose International Full timeJob SummaryWe are seeking a highly skilled and detail-oriented HR Assistant to provide comprehensive support to our Distribution Center employees. As an HR Assistant, you will be responsible for handling confidential information, performing administrative tasks, and maintaining employee and company records.Key ResponsibilitiesProvide HR support to employees,...
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Transportation Specialist I
2 weeks ago
Fairfield, United States Partnership HealthPlan of California Full timeOverview To facilitate access to medical care by coordinating Non-Emergency Medical (NEMT) Transportation, Non-Medical Transportation (NMT) transportation and travel-related benefits for members. Coordinates care in collaboration with internal and external partners to help members overcome barriers to care created by lack of transportation....
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Network Systems Specialist
2 months ago
Fairfield, New Jersey, United States A-V Services, Inc. Full timeJob SummaryA-V Services, Inc. is seeking a highly skilled Network Technician to join our team. As a Network Technician, you will be responsible for installing, configuring, and troubleshooting our network infrastructure to ensure seamless communication and data transfer.Key ResponsibilitiesNetwork Installation and Configuration: Install and configure network...