Claims Specialist II – Provider Claims

Job not on LinkedIn

🔥 14 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $27 - $35 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 2%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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IEHP

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1995

🛡️ Insurance

💼 Consulting

📦 Logistics

💰 Grant on 2021-02

Insurance • Consulting • Logistics

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

• Fulfill the technical support needs of appeals and support staff • Ensure appeals and call center tasks are conducted consistently and accurately • Handle escalated claim-related telephone inquiries • Assist with cross-training as needed • Perform complex claim adjustment projects • Process Provider Disputes in accordance with regulatory requirements • Help perform root cause analysis for identified claim issues • Interface with other business units to establish preventive solutions • Help identify training needs • Identify Lean improvements to unit workflows • Incorporate IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation

🎯 Requirements

• Four (4) years of experience in a managed care environment in the area of claims processing; appeals & adjustments, and customer service, preferably in an HMO or Managed Care setting • A thorough understanding of medical claim processing and customer service standards • Medi-Cal/Medicare experience and prior experience in a lead role preferred • High school degree or GED required • Understanding of claim appeal process, provider contracts, claim system functionality and medical claim processing practices • Strong analytical and problem-solving skills • Microsoft Office and Advanced Microsoft Excel • Microcomputer skills and proficiency in Windows applications preferred • Excellent oral and written communication skills • Excellent communication and interpersonal skills • Customer service skills and data entry required • Typing a minimum of 45 wpm • Ability to build successful relationships across the organization • Professional demeanor and strong organization skills • High degree of patience