Claims Resolution Specialist (Customer Service) - Impresiv Health

Orange, CA 92868

About the Job

Title: Claims Resolution Specialist (Customer Service)

Duration: up to 6 months

Compensation: $25.87-$38.8077

Description: The Claims Resolution Specialist will be the first line of contact for providers. The incumbent will assist providers with questions related to the payment of claims and resolution of claims payment issues.

What You Will Do:

Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or 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.

You Will Be Successful If:

Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds.
Work independently and exercise sound judgment.
Communicate clearly and concisely, both orally and in writing.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, be analytical, problem-solve and possess project management skills.
Work in a fast-paced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Ability to visually read information from computer screens, forms and other printed materials and information.
Ability to speak (enunciate) clearly in conversation and general communication.
Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lifting and moving objects, patients and/or equipment 10 to 25 pounds

What You Will Bring:

High School diploma or equivalent required.
2 years of experience in claims resolution required.
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.
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.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv!

Source : Impresiv Health