IEHP · 23 hours ago
Claims Specialist Quality Assurance I
CA, US
Full-time
Remote
Entry Level
$25.90/hr - $33.02/hr
2+ years exp
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Responsibilities
Review and assess data reports and audit Claim Processor output to confirm payment accuracy and completeness of data entry
In-house expert for claims adjudication (Coordination of Benefits, pricing, contract interpretation, coding, and resolution of claims issues)
Ensure that all identified errors are corrected in an expedient manner
Be an active participant in the Claims Department’s initiatives and participate in the Claims Coaching process, MDI activities, etc.
Assist with the processing of claims when necessary to address claims backlogs. Process approved Stop Loss reimbursements
Qualification
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Required
Two (2) years of experience in examining and processing institutional and professional claims
High school diploma or GED required
Preferred
Medicare/Medi-Cal experience preferred
Experience in a managed care environment helpful
ICD-9/ ICD-10 and CPT coding and general practices of claims processing
Familiarity of Webstrat, Optum and CMS pricing
Benefits
Competitive salary.
Hybrid schedule.
CalPERS retirement.
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
IEHP, Inland Empire Health Plan, is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country.
1,001-5,000 employees
Funding
Current Stage
Late StageTotal Funding
$32.38M2021-02-04Grant· $32.38M
Leadership Team
Susie White
Chief Operating Officer
Katherine A. Kang
Vice President, HR Strategic Initiatives and Business Partners
Recent News
2024-11-26
2024-11-20
Company data provided by crunchbase
