Pacific Medical Centers · 15 hours ago
Claims Specialist - USFHP
Renton, WA
Full-time
Onsite
Entry, Mid Level
$21.01/hr - $32.57/hr
2+ years expPacific Medical Centers is a private, not-for-profit health care network that provides patient-centered care. The Claims Specialist role involves adjudicating claims, adjusting complex claims for processing, and responding to customer service requests to resolve claim issues.
Health CareMedical
Responsibilities
Adjudicates claims submitted by outside purchased services for PMC's enrolled capitated population and communicates those actions
Adjusts complex claims for advanced processing needs
Responds to Customer Service Requests and resolves problem claim situations
Qualification
Required
H.S. Diploma or GED or equivalent experience in Health Care Business Administration
2 years in Managed Care operations
1 year of Claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting
Experience with areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health and Encounters)
Information systems supporting the administration of managed care products
Preferred
IDX healthcare software application
CHAMPUS, Medicare and/or Medicaid benefits/programs
Benefits
Retirement 401(k) Savings Plan with employer matching
Health care benefits (medical, dental, vision)
Life insurance
Disability insurance
Time off benefits (paid parental leave, vacations, holidays, health issues)
Voluntary benefits
Well-being resources
Company
Pacific Medical Centers
Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Kriska Floresca
HR Business Partner
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