Certified Call Center Claims Processor I

AllCare Health, Inc.; Grants Pass (OR); On-site; USD 27,552 - 33,062; Full time

Benefits offered by this job

Affordable healthcare

401(k) retirement

Flexible schedule options

Wellness programs

Job summary

AllCare Health, Inc. is seeking a Certified Call Center Claims Processor I in Grants Pass, Oregon. This position involves acting as the primary contact for provider inquiries while resolving claims issues and ensuring compliance with coding guidelines.

The ideal candidate must hold an associate degree, possess current coding certification, and have experience in healthcare claims processing. The role offers a competitive hourly wage, flexible scheduling, and excellent benefits, including healthcare and a 401(k) plan.

Qualifications

• Six months to one year of experience in healthcare claims processing.
• Experience in resolving claim-related issues preferred.
• Proficient in ICD-10-CM, CPT, and HCPCS coding systems.

Responsibilities

• Respond to inbound provider calls and resolve inquiries.
• Research and resolve claim issues accurately.
• Maintain documentation of provider interactions and claims.

Skills

Customer service skills

Claims processing knowledge

Bilingual skills

Organizational skills

Time management skills

Education

Associate degree or equivalent

Current coding certification (CPC, CPC-P)

Tools

Microsoft Office Suite

Healthcare claims processing systems

EZ-CAP

Job description

Certified Call Center Claims Processor I

Location: Grants Pass, Oregon, USA

Salary Range: $20.00 to $24.00 hourly

Summary of the Position

The Certified Claims Call Center Processor I serves as the primary point of contact for provider offices and authorized representatives, responding to inbound calls and electronic inquiries regarding professional and facility claims processing and adjudication. This role combines customer service and certified claims processing responsibilities by independently resolving provider inquiries, researching claim issues, and adjudicating professional claims in accordance with company policy, contract language, coding guidelines, and applicable regulatory requirements.

Responsibilities

• Respond promptly and professionally to inbound provider calls, emails, and other inquiries regarding claim status, adjudication outcomes, benefits, pricing, coding, and payment determinations.
• Independently research and resolve professional claim issues by reviewing claim history, coding, benefits, pricing logic, contract language, and applicable system edits.
• Accurately adjudicate professional claims using CPT, HCPCS, ICD‑10 coding guidelines, reimbursement methodologies, benefit plans, and regulatory requirements.
• Maintain accurate and detailed documentation of provider interactions, claim research, resolutions, and claim adjustments within the core claims system and tracking tools.
• Explain claim outcomes, billing requirements, and processing guidelines to providers and their representatives while promoting positive provider relationships.
• Coordinate benefits by reviewing member eligibility, payer responsibility, and other insurance coverage information to ensure accurate application of coordination of benefits guidelines.
• Identify recurring claim issues, processing trends, or potential system concerns and escalates findings as appropriate.
• Communicate and collaborate effectively with providers, members, leadership, and internal departments to support timely and accurate issue resolution.
• Maintain compliance with HIPAA, PHI, claim routing procedures, inventory control standards, quality benchmarks, production expectations, and other applicable policies and regulatory requirements.
• Participate in a rotating call coverage schedule, including primary phone coverage and fill‑in support during breaks, lunches, and periods of increased call volume, while assisting with claims processing as operational needs permit.
• Demonstrate flexibility and teamwork by assisting peers and supporting departmental workflows and operational priorities.
• Participate in ongoing training and continuing education to maintain coding certification and remain current on coding, reimbursement, regulatory, and industry changes.
• Maintain punctual, regular, and predictable attendance.
• Work collaboratively in a team environment and respectfully follow leadership direction.
• Perform other duties as assigned.

Qualifications

• Associate degree (AA) from a two‑year college or technical school required, or an equivalent combination of education and experience.
• Six months to one year of experience in healthcare claims processing, medical billing, provider services, customer service, or a related healthcare administrative role.
• Experience reviewing, researching, and resolving claim‑related issues preferred.
• Experience using healthcare claims processing systems preferred.
• EZ‑CAP experience preferred.
• Current coding certification from the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) required (e.g., CPC, CPC‑P).
• Working knowledge of ICD‑10‑CM, ICD‑10‑PCS, CPT, and HCPCS coding systems.
• Knowledge of CMS‑1500, UB‑04, and other healthcare claim forms.
• Strong organizational and time‑management skills.
• Proficient computer skills, including Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).
• Ability to maintain compliance with HIPAA regulations.

Bilingual Skills

Being bilingual in another language, including American Sign Language (ASL), is an invaluable skill that enhances our ability to deliver culturally responsive care and is strongly encouraged.

Physical Demands & Work Environment

The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand, walk, and reach with hands and arms. The noise level is usually moderate.

Company Overview

AllCare Health offers competitive wages and an excellent benefits package, including affordable healthcare, 401(k) retirement, wellness programs, and flexible schedule options.

EEO Statement

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.

Application Process

If you need accommodations, help in the application process, or wish to receive this job announcement in an alternative format, please call 541‑471‑4106 and ask for Human Resources.

Work Schedule

8:00 AM – 5:00 PM with a 1 hour paid lunch and two 15 minute unpaid breaks (40 hours per week).