Claims Processor, Specialist

Blue Shield of California • Woodland Hills, CA

4d • Hybrid

About The Position

Your Role The Medi-Cal Operations team is responsible for ensuring claims are processed accurately and timely. The Claims Processor, Specialist will report to the Medi-Cal Operations Supervisor. In this role you will be responsible for interfacing with other departments and vendors involved in the Claims process and will also serve as the primary point of contact for priority claim cases. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Requirements

• Requires a high school diploma or GED
• Requires at least 7 years of experience
• Minimum of 3 years of experience in claims processing and/or auditing experience in a manage care setting required
• Proficiency in Microsoft Office programs such as Excel, Word and Outlook required

Nice To Haves

• Experience examining multiple claim types in the Medi-Cal/Medicare environment preferred
• Knowledge of medical claims regulatory guidelines such as AB1455 and Medicare preferred

Responsibilities

• Handle most complex activities including backup for all areas of claims processing
• Actively participate in projects
• Handle escalated issues independently
• Mentor experienced team members
• Assist with training when needed
• Collaborate with peers, staff in other department's vendors, and Management to improve processes and department work quality.
• Must be able to work in a fast-paced environment with minimal supervision
• Read and interpret documents such as provider contracts procedure manuals, various reports, division of financial responsibility matrix

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 1-10 employees