Claims Specialist - USFHP
About The Position
Adjudicates claims submitted by outside purchased services for PMC's enrolled capitated population and communicates those actions. Adjusts complex claims for advanced processing needs. Responds to Customer Service Requests and resolves problem claim situations. Providence caregivers are not simply valued – they’re invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Requirements
- H.S. Diploma or GED or equivalent experience in Health Care Business Administration.
- 2 years in Managed Care operations.
- 1 year of Claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.
- Experience with areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health and Encounters).
- Information systems supporting the administration of managed care products.
Nice To Haves
- IDX healthcare software application.
- CHAMPUS, Medicare and/or Medicaid benefits/programs.
Benefits
- Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security.
- We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
