IEHP
Healthcare Insurance • Finance • Social Impact
IEHP is a health plan dedicated to serving low-income individuals and families in Riverside and San Bernardino counties. They offer a variety of programs including Medi-Cal, DualChoice, and Covered California, providing healthcare coverage for residents who may not otherwise have access to necessary medical services. With a focus on holistic health and community wellness, IEHP partners with local doctors and facilities to ensure comprehensive care for their members, supporting them with resources in mental health, fitness classes, and wellness education.
Claims Specialist
Job not on LinkedIn
November 10
IEHP
Healthcare Insurance • Finance • Social Impact
IEHP is a health plan dedicated to serving low-income individuals and families in Riverside and San Bernardino counties. They offer a variety of programs including Medi-Cal, DualChoice, and Covered California, providing healthcare coverage for residents who may not otherwise have access to necessary medical services. With a focus on holistic health and community wellness, IEHP partners with local doctors and facilities to ensure comprehensive care for their members, supporting them with resources in mental health, fitness classes, and wellness education.
📋 Description
• Find joy in serving others with IEHP! • Analyze, manage, and investigate complex and high-dollar healthcare claims that require in-depth research to determine accuracy and mitigate payment errors. • Adjust first-pass and post-pay claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. • Collaborate with internal stakeholders, assist with claim audits (internal and regulatory) and utilize strong analytical skills and independent judgment skills to make effective and accurate decisions. • Respond to inquiries from the Provider Payment Resolution team on claims that may have been paid incorrectly. • Remain current with all claim processing changes/updates (i.e. internal processes, regulatory guidelines).
🎯 Requirements
• Three (3) years of experience in examining and processing complex and high-dollar institutional and professional claims • Experience in a managed care environment helpful • Commercial, Exchange, and Medicare preferred • High school diploma or GED required • Associate’s degree from an accredited institution preferred • ICD-9/ ICD-10 and CPT coding and general practices of claims processing • CMS/DMHC and Affordable Care Act regulations and guidelines • Commercial line of business specifically Covered California/Exchange • Excellent communication and interpersonal skills • Excellent analytical, critical thinking, customer service, and organizational skills • Ability to think critically with the capacity to work independently
🏖️ Benefits
• Competitive salary • Telecommute schedule • State of the art fitness center on-site • Medical Insurance with Dental and Vision • Life, short-term, and long-term disability options • Career advancement opportunities and professional development • Wellness programs that promote a healthy work-life balance • Flexible Spending Account – Health Care/Childcare • CalPERS retirement 457(b) option with a contribution match • Paid life insurance for employees • Pet care insurance
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