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IEHP · 1 day ago

Claims Specialist - Covered California

Rancho Cucamonga, CA

Full-time

Hybrid

Mid Level

$25.90/hr - $33.02/hr

3+ years exp

IEHP is dedicated to healing and inspiring the human spirit, and they are seeking a Claims Specialist to manage and investigate complex healthcare claims. The role involves analyzing claims for accuracy, adjusting payments, and collaborating with stakeholders to ensure quality and compliance.

Health CareHealth DiagnosticsHospital

Comp. & Benefits

Responsibilities

Analyzing, managing, and investigating complex and high-dollar healthcare claims

Adjusting first-pass and post-pay claims that result in overpayment or underpayment

Collaborating with internal stakeholders

Assisting with claim audits (internal and regulatory)

Responding to inquiries from the Provider Payment Resolution team on claims

Qualification

ICD-9/ICD-10 codingCPT codingClaims processingCMS/DMHC regulationsAffordable Care ActManaged care experienceAnalytical skillsCustomer service skillsCommunication skillsCritical thinkingOrganizational skills

Required

Three (3) years of experience in examining and processing complex and high-dollar institutional and professional claims

High school diploma or GED required

ICD-9/ ICD-10 and CPT coding and general practices of claims processing

CMS/DMHC and Affordable Care Act regulations and guidelines

Commercial line of business specifically Covered California/Exchange

Excellent communication and interpersonal skills

Excellent analytical, critical thinking, customer service, and organizational skills

Ability to think critically with the capacity to work independently

All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership

Preferred

Experience in a managed care environment helpful. Commercial, Exchange, and Medicare preferred

Associate's degree from an accredited institution preferred

Benefits

Telecommute schedule

State of the art fitness center on-site

Medical Insurance with Dental and Vision

Life, short-term, and long-term disability options

Career advancement opportunities and professional development

Wellness programs that promote a healthy work-life balance

Flexible Spending Account – Health Care/Childcare

CalPERS retirement

457(b) option with a contribution match

Paid life insurance for employees

Pet care insurance

Company

IEHP

Glassdoor3.8

With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans, the largest not-for-profit Medicare-Medicaid public health plan in the country, and for the fourth year in a row, certified as A Great Place To Work®.

Founded in 1995

Rancho Cucamonga, California, USA

1001-5000 employees