Lead Claims Specialist – Claims Processing

🔥 4 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $27 - $42 / hour

⏰ Full Time

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Providence

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1856

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Providence is a not-for-profit health system committed to providing a wide range of medical services, including primary care, urgent care, pediatrics, maternity care, cancer treatment, and specialized services like neurosurgery and orthopedics. They offer both in-person and virtual care through clinics and a mobile app, ensuring patients can access healthcare conveniently. With a mission rooted in compassion, dignity, and justice, Providence emphasizes serving those who are vulnerable and strives for excellence in healthcare delivery. They are involved in research and innovation, including genomic profiling and clinical trials to improve patient outcomes.

📋 Description

• Manage claims internal audit functions, including audits of adjudicated claims and encounters • Monitor the check run process for accuracy • Develop policies and procedures for periodic claims audits • Ensure compliance with affiliated health plans, client groups, and administrative contractual agreements • Design, plan, direct, and implement claims training programs • Adapt training programs to changes in policies, procedures, and technologies • Ensure customer (provider-vendor) satisfaction while maintaining integrity • Serve as a liaison between contracted health plans, patients, hospitals, and the Information Technology Department • Provide day-to-day assistance and training on claims compliance matters to Claims Examiners and Adjudication teams • Support customer-measured quality and responsiveness requirements

🎯 Requirements

• 5 years of professional and facility claims processing experience • Familiarity with applicable State and Federal claim payment and denial timeliness legislation • Familiarity with Timeliness Compliance pursuant to State and Federal rules and regulations • Knowledge of the Provider Dispute Resolution tracking mechanism (AB1455)

🏖️ Benefits

• Retirement 401(k) Savings Plan with employer matching • Medical, dental, and vision health care benefits • Life insurance • Disability insurance • Paid parental leave • Vacation and holiday time off • Time off for health issues • Voluntary benefits • Well-being resources • Additional compensation may be available through shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities