Claims Specialist - Claims Processing

Providence • Anaheim, CA

1d • Onsite

About The Position

Responsible for processing medical claims. Resolves complex, difficult or non-routine claims requiring special handling in accordance with established policy guidelines. Reviews and authorizes payment and final disposition of claims requiring adjustment and claims benefit determination for reinsurance qualification. Handles complex, difficult or non-routine incoming and outgoing telephone inquiries regarding claims status, benefit quotations, benefit determination and denial information. Interacts with IPAs, Medical Groups, Providers, Hospitals and Members. Responds to written inquiries received from the above-named groups. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation 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

• HMO claims processing experience in a managed care environment, preferably PMG/IPA setting within the last 3 years or any combination of education and/or experience which produces an equivalency.

Responsibilities

• Processing medical claims.
• Resolving complex, difficult or non-routine claims requiring special handling in accordance with established policy guidelines.
• Reviewing and authorizing payment and final disposition of claims requiring adjustment and claims benefit determination for reinsurance qualification.
• Handling complex, difficult or non-routine incoming and outgoing telephone inquiries regarding claims status, benefit quotations, benefit determination and denial information.
• Interacting with IPAs, Medical Groups, Providers, Hospitals and Members.
• Responding to written inquiries received from the above-named groups.

Benefits

• Best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed