Claims Specialist Quality Assurance I

Inland Empire Health Plans; California (MO); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical, dental, and vision insurance

Life and disability coverage

Career development

Job summary

Inland Empire Health Plans is looking for a Claims Specialist Quality Assurance to oversee the integrity of data created and updated by the Claims Processing staff. You will use quality auditing tools, identify training needs, and help define efficient methods for accurate data entry and adjudication.

The role supports IEHP's commitment to quality initiatives like HEDIS, CAHPS, and NCQA Accreditation, with a focus on ensuring accurate claims processing in a managed care setting.

Qualifications

• Two years of experience examining and processing institutional and professional claims.
• Experience with Medicare/Medi-Cal preferred.
• Experience in a managed care environment helpful.

Responsibilities

• Ensure data integrity for all claims processed by staff.
• Utilize quality auditing tools and identify training needs.
• Define efficient methods for accurate data entry and adjudication.

Skills

Quality audits

Data entry accuracy

Claims processing

Communication skills

Education

High school diploma or GED

Tools

Webstrat

Optum

CMS pricing

Job description

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to anauthentic experience!

Under the direction of the Claims Quality Assurance (QA) Manager and Supervisor, the Claims Specialist Quality Assurance (CSQA) is responsible for ensuring the integrity of all data created and updated by the Claims Processing staff. The CSQA will utilize quality auditing tools, identify training needs, and define effective and efficient methods for accurate data entry and adjudication.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account - Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Education & Requirements

• Two (2) years of experience in examining and processing institutional and professional claims
• Medicare/Medi-Cal experience preferred
• Experience in a managed care environment helpful
• High school diploma or GED required

Key Qualifications

• ICD-9/ ICD-10 and CPT coding and general practices of claims processing. Familiarity of Webstrat, Optum and CMS pricing
• Excellent communication and interpersonal skills, strong organizational skills
• Microcomputer skills, proficiency in Windows applications preferred
• Professional demeanor