Healthcare Utilization & Member Support Coordinator

Sharp HealthCare; San Diego (CA); Remote; USD 36,000 - 50,000; Full time

Job summary

Sharp HealthCare is seeking a dedicated support specialist to provide education, research, and informational assistance to internal and external customers of Sharp Community Medical Group.

The role emphasizes utilization management data analysis, claims status research, and effective patient and provider communication. A high school diploma and experience in managed care and call centers are required.

Qualifications

• High School diploma or equivalent.
• 3 years' experience in managed health care focusing on claims, eligibility, appeals and benefits.
• 1 year experience in a high-volume call center.

Responsibilities

• Collect and compile utilization data to assist Utilization Management.
• Provide excellent customer service; handle calls with a 100% quality standard.
• Research and advise on the status of claims adjudication, eligibility referrals, and appeals.
• Develop educational programs to educate providers on referrals and eligibility processes.
• Maintain relationships with claims and Health Services Management for issue resolution.
• Perform all other duties as assigned.

Skills

Call center experience

Healthcare experience

High school diploma

Job description

Sharp HealthCare is seeking a dedicated support specialist to provide education, research, and informational assistance to internal and external customers of Sharp Community Medical Group.

The role emphasizes utilization management data analysis, claims status research, and effective patient and provider communication. A high school diploma and experience in managed care and call centers are required.