Claims Specialist – Quality Assurance I

🔥 15 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $25 - $33 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔧 QA Engineer (Quality Assurance)

🚫👨‍🎓 No degree required

👻 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

• Ensure the integrity of all data created and updated by Claims Processing staff • Utilize quality auditing tools • Identify training needs • Define effective and efficient methods for accurate data entry and adjudication • Incorporate IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation • Work under the direction of the Claims Quality Assurance Manager and Supervisor

🎯 Requirements

• Two (2) years of experience in examining and processing institutional and professional claims • Medicare/Medi-Cal experience preferred • Experience in a managed care environment helpful • High school diploma or GED required • ICD-9/ ICD-10 and CPT coding and general practices of claims processing • Familiarity of Webstrat, Optum and CMS pricing • Excellent communication and interpersonal skills • Strong organizational skills • Microcomputer skills • Proficiency in Windows applications preferred • Professional demeanor

🏖️ Benefits

• Competitive salary • 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