Claims Specialist

Are you an experienced Claims Specialist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Company Job Description/Essential Functions:

Review and process provider dispute resolutions according to state and federally defined timeframes.

Research issues; adjust claims, including computation of interest owed as appropriate.

Send written responses to providers in a professional manner within required timelines.

Forward cases to the IRE or the DMHC as needed.

Answer provider inquiries regarding disputes that have been submitted.

Maintain and track disputes through HPSM’s grievance and appeals database.

Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed.

2+ years’ experience working with medical claims (Example: Claims Examiner, Claims Provider Services Rep)

Must have experience in a health services and/or managed care setting

Medi-Cal & Medicare program knowledge

Must be well-versed in medical claims and reimbursement process

Experience with Microsoft Office software

Advantages of this Opportunity:

• Hours for this Position: Monday- Friday 8:00am to 5:00pm

• Pay up to $22 per hour, negotiable

• Immediate opening, Temp-to-Perm position with excellent benefits offered.

If you know of someone looking for a new opportunity, please pass along the information! We offer referral bonuses of up to $100.00 for each placement.