Claims Resolution Specialist (Health Insurance Programs)

Location: Orange, CA

Pay: $25-$30/hour

Schedule: Mon to Fri (8am-5pm) ON SITE

Type: Temporary to Hire

Qualifications

• High School diploma or equivalent PLUS 2 years of experience in claims resolution required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying
• 1 year of call center experience with high call volumes or customer service experience required
• 1 year of HMO, Medi-Cal/Medicaid and healthcare/managed care experience required

Benefits

• Pay: $25.00 - $36.00 per hour
• Expected hours: 40 per week
• 8 hour shift
• Monday to Friday

Responsibilities

• 80% - Claims Support
• Responds to provider questions and researches issues regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures
• Follows up with providers as needed
• 15% - Administrative Support
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department
• Ensures accurate and timely documentation regarding all issues, and/or inquiries are entered in Facets
• Routes escalated calls to the appropriate departments and/or management
• 5% - Completes other duties or projects as assigned

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county, to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.