Claims Specialist II Provider Claims
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience!
The Claims Specialist II Provider Claims is responsible for fulfilling the technical support needs of appeals and support staff, while ensuring that appeals and call center tasks are conducted consistently and accurately. Additional responsibilities include handling escalated claim-related telephone inquiries, assisting with cross-training as needed, performing complex claim adjustment projects, and processing Provider Disputes in accordance with regulatory requirements.
Additionally, the Claims Specialist II Provider Claims will help perform root cause analysis for identified claim issues and interface with other business units to establish preventive solutions. The Claims Specialist II Provider Claims will help identify training needs and identify Lean improvements to all unit workflows.
Commitment to Quality: The IEHP Team is committed to incorporate IEHPs Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
Competitive salary
CalPERS retirement.
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
Education & 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 diploma or GED required
Key Qualifications
Must have a valid California Drivers license
Understanding of claim appeal process, provider contracts, claim system functionality and medical claim processing practices
Strong analytical and problem-solving skills
Microsoft Office, Advanced Microsoft Excel
Microcomputer skills, proficiency in Windows applications preferred
Excellent oral and written communication skills
Excellent communication and interpersonal skills
Customer service skills and skilled in 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
Start your journey towards a thriving future with IEHP and apply TODAY!
Apply Now
Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience!
The Claims Specialist II Provider Claims is responsible for fulfilling the technical support needs of appeals and support staff, while ensuring that appeals and call center tasks are conducted consistently and accurately. Additional responsibilities include handling escalated claim-related telephone inquiries, assisting with cross-training as needed, performing complex claim adjustment projects, and processing Provider Disputes in accordance with regulatory requirements.
Additionally, the Claims Specialist II Provider Claims will help perform root cause analysis for identified claim issues and interface with other business units to establish preventive solutions. The Claims Specialist II Provider Claims will help identify training needs and identify Lean improvements to all unit workflows.
Commitment to Quality: The IEHP Team is committed to incorporate IEHPs Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
Competitive salary
CalPERS retirement.
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
Education & 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 diploma or GED required
Key Qualifications
Must have a valid California Drivers license
Understanding of claim appeal process, provider contracts, claim system functionality and medical claim processing practices
Strong analytical and problem-solving skills
Microsoft Office, Advanced Microsoft Excel
Microcomputer skills, proficiency in Windows applications preferred
Excellent oral and written communication skills
Excellent communication and interpersonal skills
Customer service skills and skilled in 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
Start your journey towards a thriving future with IEHP and apply TODAY!
Apply Now