Claims Specialist
Posted 3 months ago Expired
This job has expired
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Upload Your ResumeAbout This Role
This role involves adjudicating and adjusting complex claims from outside purchased services for Pacific Medical Centers' capitated population. The specialist will also respond to customer service requests and resolve problematic claim situations.
Responsibilities
- Adjudicate claims submitted by outside purchased services for PMC's enrolled capitated population
- Communicate actions taken on claims
- Adjust complex claims for advanced processing needs
- Respond to Customer Service Requests
- Resolve problem claim situations
Requirements
- 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)
- Knowledge of information systems supporting the administration of managed care products
Qualifications
- H.S. Diploma or GED or equivalent experience in Health Care Business Administration.
- 2 years in Managed Care operations and 1 year of Claims processing experience
Nice to Have
- Experience with IDX healthcare software application
- Knowledge of CHAMPUS, Medicare and/or Medicaid benefits/programs
Skills
* Required skills
Benefits
About Pacific Medical Centers
Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers. It is affiliated with the Providence family.