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Partnership HealthPlan of California · 1 day ago

Claims Specialist

Sonoma County, CA

Full-time

Onsite

Mid Level

$28.63/hr - $37.22/hr

3+ years exp

Partnership HealthPlan of California is looking for a Claims Specialist to support the Claims Department in managing pended claims and adjustments. The role involves processing complex claims and providing assistance in various claims-related functions while ensuring compliance with established guidelines.

Health CareInsuranceNon Profit

Culture & Values

Responsibilities

Researches and processes claim adjustment requests

Participates in special claim adjustment projects as assigned

Assists in maintaining pended claim reports and files within established department guidelines and program policies

Performs claims examining functions as assigned

Performs claims customer service functions as assigned

Assists in training claims staff as needed

Monitors efficiency of operations and provides feedback to management on possible effective procedure changes

Records daily production statistics and related activities on appropriate reports; turns all logs and reports into the Claims Supervisor

Other duties as assigned

Qualification

Claims examining experienceMedi-Cal claims processingCPT coding knowledgeICD-9 coding knowledgeTyping speed 30 wpm10-key calculator proficiencyHandle sensitive issuesCommunication skillsOrganizational skills

Required

Minimum three (3) years claims examining experience

Partnership claims examining experience and completion of Partnership claims training; or equivalent combination of education and experience

Familiarity with Medi-Cal and/or managed care claims processing

Knowledge of CPT, HCPC procedure coding, and ICD-9 diagnostic coding

Knowledge of Partnership Claim Policy and Procedures, EDS provider manual guidelines, Title 22 regulations and any other required policies, procedures, regulations, and manuals

Typing speed 30 wpm and proficient use of 10-key calculator

Valid California driver's license and proof of current automobile insurance compliant with Partnership policy

Excellent oral and written communication skills

Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy

Ability to work on multiple tasks within established time frames and sometimes with conflicting priorities

Good organizational skills with ability to maintain accurate records and documentation of actions and decisions

Ability to use a computer keyboard; more than 80% of work time is spent in front of a computer monitor

When required, ability to move, carry, or lift objects of varying sizes, weighing up to 25 lbs

Ability to attend off-site meetings as required

Preferred

College course work in business or related field

Company

Partnership HealthPlan of California

Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

Founded in 1994

Fairfield, California, USA

1001-5000 employees