Claims Provider Representative I

OMNIA Partners; Golden Horseshoe; On-site; CAD 60,000 - 80,000; Full time

Job summary

An established industry player is looking for a Claims Provider Representative I to join their dynamic team. In this role, you will assist medical providers in understanding claims policies and resolving issues efficiently. Your responsibilities will include managing high-volume calls, educating providers on billing procedures, and documenting all interactions. This position offers an excellent opportunity to grow in a supportive environment while contributing to improving provider satisfaction. If you thrive in a fast-paced setting and enjoy problem-solving, this role is perfect for you.

Benefits

Medical, Dental, and Vision Coverage

Fully Paid Life, AD&D, and LTD Insurance

Retirement Plan with Employer Contribution

Qualifications

• 2 years experience in a high-volume call center, preferably in healthcare.
• Knowledge of Medicare and Medi-Cal programs and medical terminology.

Responsibilities

• Handle high-volume calls and assist providers with claims submission.
• Document actions and communicate issues to relevant departments.

Skills

Effective Communication

Problem Solving

Team Collaboration

Adaptability

Education

High School Diploma or GED

Associate of Arts Degree

Tools

Microsoft Office Suite

Personal Computers

Job description

801 Gateway Blvd, South San Francisco, CA 94080, USA ● Virtual Req #123

Friday, January 10, 2025

Claims Provider Representative I

Under general supervision, help providers understand the policies and procedures in submitting claims, and assist in solving providers’ claim problems of a routine nature to ensure they are processed and paid on a timely basis.

Position Overview

1. Respond and handle high-volume calls via call center queue, voicemails, emails and faxes from medical providers and others, answering their questions and assisting in the resolution of issues relating to claims submission and payment.
2. Research, identify, refer, resolve and follow-up regarding problems and notify others of findings and provide recommendations for system or process improvement.
3. Document all actions in Call Log and respond to open issues in a timely manner.
4. Educate others regarding program information and proper medical claims billing procedures with the goal of improving and maintaining provider satisfaction.
5. Communicate newly identified and potential issues to the Lead, Claims Managers, and other departments as necessary.

Secondary Functions

1. Attend Team Meetings for ongoing training and development.
2. Perform other duties as assigned.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.

Education and Experience

1. High School diploma, GED or equivalent required.
2. Associate of Arts degree in a related field a plus.
3. Two (2) years’ experience working in a high-volume call center with at least one (1) in a healthcare environment.
4. Medi-Cal and Medicare experience preferred.

Knowledge of

1. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint.
2. Medicare and Medi-Cal programs.
3. HCPCS, CPT, ICD-9 and Revenue coding.
4. HIPAA regulations.
5. Medical terminology.

Ability to

1. Work cooperatively with others.
2. Work as part of a team and support team decisions.
3. Communicate effectively, both verbally and in writing.
4. Adapt to changes in requirements/priorities for daily and specialized tasks.
5. Be a self-starter.
6. Independently solve problems and organize own workload according to department priorities and deadlines.

Salary and Benefits

The starting salary range is $22.76 - $28.79 per hour, depending on the candidate’s work experience.

Excellent benefits package includes:

• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums).
• Fully paid life, AD&D and LTD insurance.
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation).