Current jobs related to Claims Support Specialist I - Fairfield, California - Partnership HealthPlan of California
-
Claims Resolution Specialist
2 weeks ago
Fairfield, California, United States Partnership HealthPlan of California Full timeJob SummaryWe 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 ResponsibilitiesRespond...
-
Claims Examiner II
2 weeks ago
Fairfield, California, United States Yoh Full timeJob Title: Claims Examiner IIYoh is seeking a skilled Claims Examiner II to join our team in Redding, CA. As a Claims Examiner II, you will be responsible for reviewing, researching, and resolving pended claims for Medi-Cal types, including medical, ancillary, long-term care, CHDP, encounter data, other coverage, and batch claims.Key Responsibilities:Review...
-
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...
-
Behavioral Health Specialist I
1 month ago
Fairfield, California, United States Turning Point Community Programs Full timeJob SummaryTurning Point Community Programs is seeking a skilled Behavioral Health Specialist I to provide psychosocial, rehabilitation, and recovery-oriented services to our members. This role involves advocating for members in all areas of treatment, helping them apply for and receive services, and providing support in medication management, resource...
-
Health Care Specialist I
1 week ago
Fairfield, California, United States Fairfield-Suisun Unified Full timeAbout Fairfield-Suisun Unified School District, a premier learning community that empowers each student to thrive in an ever-changing world. We are seeking a skilled Health Care Specialist I to join our team. The ideal candidate will possess a valid California Driver's License, a California Licensed Vocational Nurse Certificate, and a valid First Aid/CPR...
-
Behavioral Health Specialist I
6 days ago
Fairfield, California, United States Turning Point Community Programs Full timeJob SummaryTurning Point Community Programs is seeking a skilled Behavioral Health Specialist I to join our Transitional Support Services (TSS-Fairfield) program in Fairfield, CA. As a key member of our team, you will provide psychosocial, rehabilitation, and recovery-oriented services to our clients, empowering them to achieve their goals and improve their...
-
Behavioral Health Specialist I
6 days ago
Fairfield, California, United States Turning Point Community Programs Full timeJob SummaryTurning Point Community Programs is seeking a dedicated Behavioral Health Specialist I to join our Transitional Support Services (TSS-Fairfield) program in Fairfield, CA. As a key member of our team, you will provide psychosocial, rehabilitation, and recovery-oriented services to our clients, empowering them to achieve their goals and improve...
-
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,...
-
Administrative Support Specialist
2 weeks ago
Fairfield, California, United States DaVita Full timeDaVita is seeking a highly organized and detail-oriented Administrative Support Specialist to join our team. As an Administrative Support Specialist, you will provide administrative support to a team of healthcare professionals, ensuring the timely and accurate completion of tasks and projects.Key responsibilities include:Providing administrative support to...
-
Administrative Support Specialist
6 days ago
Fairfield, California, United States DaVita Full timeAbout the Role:We are seeking a highly skilled and detail-oriented Administrative Support Specialist to join our team at DaVita. As an Administrative Support Specialist, you will play a vital role in ensuring the timely and accurate completion of administrative tasks, including change requisitions, treatment logs, patient charts, invoices, and purchase...
-
IT Support Specialist
2 weeks ago
Fairfield, California, United States TAJ Technologies Inc Full timeJob SummaryAs an IT Support Specialist at TAJ Technologies Inc, you will play a critical role in ensuring the availability and reliability of our organization's information systems. You will be responsible for monitoring computer application processes, performing specific tasks in relation to the support of the I.T. Helpdesk, and escalating problems as...
-
Imaging Support Specialist
6 days ago
Fairfield, California, United States NorthBay Health Full timeJob SummaryWe are seeking a highly organized and detail-oriented Imaging Support Specialist to join our team at NorthBay Health. In this role, you will be responsible for obtaining billing documentation and authorizations for patient imaging exams, verifying patient eligibility and benefits, and scheduling exams for multiple diagnostic modalities.Key...
-
Classroom Support Specialist
1 month ago
Fairfield, California, United States Fairfield-Suisun Unified Full timeAbout the Employer Fairfield-Suisun Unified School District is a premier learning community that empowers each student to thrive in an ever-changing world. Our Mission We are committed to providing a safe and inclusive learning environment that fosters academic excellence, social responsibility, and emotional well-being. Job Summary We are seeking a...
-
Behavioral Support Specialist
3 weeks ago
Fairfield, California, United States Seneca Family of Agencies Full timeAbout Seneca Family of AgenciesSeneca Family of Agencies is a leading provider of mental health, community-based, and educational services to traditionally marginalized communities. We are committed to building a diverse staff and strongly encourage people of color to apply.Job SummaryWe are seeking a highly motivated and compassionate Behavioral Support...
-
Behavioral Health Specialist
3 weeks ago
Fairfield, California, United States Turning Point Community Programs Full timeJob Title: Behavioral Health Specialist IJob Summary:Turning Point Community Programs is seeking a highly motivated and compassionate Behavioral Health Specialist I to join our team. As a key member of our staff, you will provide psychosocial, rehabilitation, and recovery-oriented services to our members, advocating for their needs and empowering them to...
-
Administrative Support Specialist
2 weeks ago
Fairfield, California, United States California Department of Education Full timeAbout the EmployerA premier learning community that empowers each student to thrive in an ever-changing world.View Job DescriptionRequirements / QualificationsUnder general supervision, the Administrative Support Specialist will act as secretary to an administrative official in the district office, assisting with clerical and administrative details,...
-
Program Support Specialist
2 weeks ago
Fairfield, California, United States Turning Point Community Programs Full timeJob SummaryWe are seeking a highly organized and detail-oriented Program Support Specialist to join our team at Turning Point Community Programs.The successful candidate will provide administrative support to the Office Manager/Program Director, ensuring the smooth operation of the office and program activities.Key ResponsibilitiesMaintain accurate and...
-
After-school Support Specialist
6 days ago
Fairfield, California, United States Wyndy LLC Full timeJob Title: After-school Support SpecialistJob Summary: We are seeking a reliable and compassionate individual to provide support to students outside of school hours.Duties and Responsibilities:* Supervise and engage with students* Assist with homework* Promote a positive learning environmentRequirements:* Strong communication skills* Passion for helping...
-
Mental Health Specialist II
2 weeks ago
Fairfield, California, United States Solano County Full timeJob Title: Mental Health Specialist IIJoin Solano County's team of dedicated professionals in providing mental health support and counseling services to individuals in need.Job Summary:The Mental Health Specialist II plays a vital role in providing mental health support and counseling services to individuals in need. This position assists in the provision...
-
Fairfield, California, United States Strategies to Empower People Inc. Full timeJob TitleStrategies to Empower People Inc. is seeking a dedicated Behavioral Support Specialist to provide direct in-home and community support for adults with Developmental Disabilities who require a high level of behavioral and medical support.The ideal candidate will have at least six months of experience working with individuals who have regular...
Claims Support Specialist I
2 months ago
Position Overview:
As a Claims Support Specialist I, you will be responsible for investigating and addressing provider inquiries through both telephone and written communication. Your role will involve the accurate assessment of claims and participation in provider-focused meetings and initiatives.
Key Responsibilities:
- Address provider inquiries via phone, conducting thorough research on policy matters, analyzing Explanation of Payments (EOPs) and claim histories, and proposing solutions to identified issues.
- Communicate outcomes to providers regarding Claim Inquiry Forms (CIFs), claim tracers, and general correspondence within specified timelines.
- Adhere to established policies and procedures, including claims operating instructions and regulatory guidelines, while resolving claims and related issues.
- Engage in provider meetings to collaboratively address claim-related challenges.
- Provide feedback to management on procedural enhancements that could lead to improved operational efficiency.
- Document daily production metrics and related activities, submitting all reports to the Claims Customer Service Supervisor.
- Meet established performance metrics related to production and call handling.
- Contribute to special projects and assignments as necessary.
- Assist in the resolution of CIFs as required.
- Perform additional duties as assigned.
Qualifications:
Education and Experience:
A high school diploma or equivalent is required; one year of experience in claims processing within an automated environment is preferred, or a suitable combination of education and experience.
Special Skills, Licenses, and Certifications:
Familiarity with CPT, HCPC procedure coding, and ICD-10 diagnostic coding is essential. Knowledge of medical terminology is advantageous. Proficiency in using coding reference materials for accurate information is required. Typing speed of 30 words per minute and adeptness with a 10-key calculator are necessary.
Performance Competencies:
Strong written and verbal communication skills are essential. The ability to exercise sound judgment within the scope of authority and manage sensitive issues with discretion is crucial. Excellent organizational skills and the capability to complete tasks accurately within designated timeframes are required.
Work Environment and Physical Demands:
Proficiency in using a computer keyboard is necessary, as over 80% of work time will be spent in front of a computer monitor. Ability to move, carry, or lift objects weighing up to 25 lbs may be required.
Company Expectations:
All employees are expected to provide exceptional service to clients, foster teamwork and collaboration, maintain safe practices, and adhere to company policies and procedures.
Compensation:
The hiring range for this position is $34.00.
Disclaimer:
The duties and responsibilities outlined in this job description are representative and not exhaustive. The employer reserves the right to modify this job description at any time and may require employees to perform additional tasks as business needs evolve.
