Claims Customer Service Representative

7 days ago


Merced, California, United States Central California Alliance for Health Full time
About the Role

We are seeking a highly skilled Claims Customer Service Representative to join our team at Central California Alliance for Health. As a Claims Customer Service Representative, you will be responsible for providing exceptional customer service to our providers and Alliance staff, resolving claims issues, and maintaining current knowledge of claims processes and procedures.

Key Responsibilities
  • Act as a frontline customer service representative and research, resolve, and respond to inquiries regarding claims issues from providers and Alliance staff
  • Process various claim types and conduct research and analysis related to claims resolution
  • Maintain current knowledge of claims processes, procedures, and related documentation, assist in developing and maintaining internal operating procedures, and recommend coding and reimbursement changes in the Alliance's claims processing system
About the Team

We handle billing-related inquiries and issues from providers concerning treatment, services, and care of our members. Our team is dedicated to providing accessible, quality healthcare that is guided by local innovation.

Requirements
  • Knowledge of medical claims processing, administrative procedures, and standard business office practices and equipment
  • Ability to effectively and clearly document, summarize, and resolve concerns and inquiries related to claims issues and recognize those issues requiring escalation to a higher-level staff member
  • Ability to gather and evaluate information, ask appropriate questions, and utilize problem-solving skills
  • Ability to utilize a variety of computer systems, including the Alliance information system and external websites and databases
  • Ability to demonstrate strong organizational skills and attention to detail
  • Ability to perform extensive phone work in a professional manner and meet productivity and quality standards for calls
What We Offer
  • Competitive compensation package
  • Ample paid time off
  • 12 paid holidays per year
  • 401(a) retirement plan
  • 457 deferred compensation plan
  • Robust health and wellness program
  • Onsite EV charging stations
About Us

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality healthcare that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health, where you will be part of a culture that is respectful, diverse, professional, and fun, and where you are empowered to do your best work.



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