Claims Technician II

Central California Alliance for Health; Santa Cruz (CA); Hybrid; Full time

Job summary

Join a leading healthcare organization as a Claims Technician II, responsible for processing and adjudicating claims while providing support and training to team members. This role offers a hybrid work environment and competitive compensation based on location. Bring your expertise in medical terminology and claims processing to make a difference in our community.

Benefits

Medical, Dental, Vision Plans

Paid Time Off and Holidays

Retirement and Deferred Compensation Plans

Health and Wellness Programs

EV Charging Stations

Qualifications

• At least two years of administrative experience, including one year in medical claims processing.

Responsibilities

• Verify, process, and adjudicate claims.
• Assist with training new hires.
• Perform claims data entry.

Skills

Medical terminology

Claims processing practices

Utilizing computer systems

Education

High school diploma or equivalent

Tools

Windows-based systems

Word

Excel

Outlook

Job description

Claims Technician II

Location: Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California

We have an opportunity to join the Alliance as a Claims Technician II in the Claims Department.

The Claims Technician II is the full working level in the Claims Technician series, responsible for verifying, processing, and adjudicating both Level I and II claim types. This role is distinguished from Claims Technician I by these responsibilities, and from Claims Technician III by focusing on Level I and II claims and providing training and support to lower levels.

Applications will close Friday 5/16 at 5pm PT.

This position is open to current Claims Technician Temps II meeting production metrics or internal employees.

What You'll Be Responsible For

• Verify, process, and adjudicate claims, ensuring proper application of policies and standards.
• Assist with training new hires and cross-training existing Claims Technicians.
• Perform claims data entry, verifying accuracy of data entered by staff and providers.

About the Team

We support Alliance members' access to care by ensuring timely and accurate payment to network providers.

What You'll Need to Be Successful

To view the full position description and requirements, click here.

Knowledge of:

• Medical terminology, coding systems (CPT, ICD, HCPCS), and resource tools.
• Medical insurance Explanation of Benefits.
• General office equipment and Windows-based systems like Word, Excel, Outlook.

Ability to:

• Utilize various computer systems and online resources.
• Stay current with claims processing practices.
• Read and understand medical insurance Explanation of Benefits.

Education and Experience:

• High school diploma or equivalent, with at least two years of administrative experience, including one year in medical claims processing or billing, or equivalent.

Other Information

• Hybrid work environment; remote interviews via Microsoft Teams.
• Attendance at quarterly events or meetings may be required.
• In-office presence may be needed based on business needs.

Compensation

The full range varies by location:

• Zone 1 (Monterey, San Benito, Santa Cruz): $21.30 - $34.09 USD
• Zone 2 (Mariposa, Merced): $19.38 - $31.02 USD

Benefits

• Medical, Dental, Vision Plans
• Paid Time Off and Holidays
• Retirement and Deferred Compensation Plans
• Health and Wellness Programs, EV Charging Stations

About Us

We are dedicated to providing accessible, quality healthcare in a respectful, diverse, and professional environment. Join our team at Central California Alliance for Health and make a difference in our community.

We are an equal opportunity employer and participate in E-Verify. Currently, we do not sponsor visas; applicants must be authorized to work in the U.S. full-time without sponsorship.