Medical Claims Operations Specialist

6 days ago


Northridge, California, United States Regal Medical Group Full time
Company Overview

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group offers a fast-paced and exciting work environment. Our organization is dedicated to providing our employees with opportunities for growth and advancement.

Salary and Benefits

The estimated salary range for this position is between $23 - $25 per hour, depending on individual factors such as market location, job-related knowledge, licensure, skills, and experience. In addition to competitive pay, we offer a comprehensive benefits package, including employer-paid medical, pharmacy, and dental insurance, vision insurance, flexible spending account, and more.

Job Description

This position plays a critical role in the maintenance of Regal Medical Group's claims processing system. The successful candidate will be responsible for implementing data integrity initiatives, communicating programs, and ensuring all systems within their area of responsibility are reliable, responsive, and support the needs of the Regal Medical Group network.

Some key responsibilities include:

  • Implementing data integrity initiatives for all supporting system configuration, including fee schedules, provider contracts, benefits, eligibility, and other areas that support the effective operation of internal systems.
  • Communicating and implementing programs within focused areas of responsibility.
  • Communicating, monitoring, and auditing processes and procedures necessary to achieve strategic objectives.
Required Skills and Qualifications

To be successful in this role, candidates must have 3-5 years of HMO Claims Adjudication experience, in-depth knowledge of Health Care and HMO Benefit products, and excellent written and verbal communication skills. A bachelor's degree from a four-year college or appropriate industry experience and/or certification is also required.

Benefits

We offer a very generous mixture of benefits, including many employer-paid options. Some of our benefits include:

  • Health and Wellness:
    • Employer-paid comprehensive medical, pharmacy, and dental for employees
    • Vision insurance
    • Zero co-payments for employed physician office visits
    • Flexible Spending Account (FSA)
    • Employer-Paid Life Insurance
    • Employee Assistance Program (EAP)
    • Behavioral Health Services
  • Savings and Retirement:
    • 401k Retirement Savings Plan
    • Income Protection Insurance
  • Other Benefits:
    • Vacation Time
    • Company celebrations
    • Employee Assistance Program
    • Employee Referral Bonus
    • Tuition Reimbursement
    • License Renewal CEU Cost Reimbursement Program
    • Business-casual working environment
    • Sick days
    • Paid holidays
    • Mileage


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