NEOGOV · 4 days ago
Claims Resolution Specialist (Customer Service)
Orange, CA
Full-time
Onsite
Entry Level
$54K/yr - $81K/yr
2+ years expCalOptima is a mission-driven community-based organization that serves member health with excellence and dignity. They are seeking a Claims Resolution Specialist to be an integral part of the Claims Administration team, assisting providers with claims payment questions and resolving issues.
GovTechHuman ResourcesInformation TechnologySoftware
Responsibilities
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
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
Completes other duties or projects as assigned
Qualification
Required
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
CalPERS pension program and additional retirement packages.
A generous PTO program
A quality work life balance
Various wellness programs
Tuition Reimbursement
Professional development opportunities
Career development opportunities
Flexible scheduling
Company
NEOGOV
NEOGOV is the leading provider of workforce management software uniquely designed for the public sector, education, and public safety.
501-1000 employees
H1B Sponsorship
NEOGOV has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (13)
2024 (10)
2023 (10)
2022 (18)
2021 (14)
2020 (16)
Funding
Current Stage
Late StageTotal Funding
$700MKey Investors
Warburg Pincus
2025-07-28Secondary Market· $700M
2025-07-28Acquired
2021-06-02Private Equity
Leadership Team
Shane Evangelist
CEO
Brandon McDonald
Head Of Marketing
Recent News
Canada NewsWire
2025-11-14
2025-11-14
Government Technology US
2025-10-31
Company data provided by crunchbase