Lead Claims Specialist

Prominence Health; Reno (NV); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Competitive Compensation & Generous PA

Excellent Medical, Dental, Vision and

401(K) with company match and stock

SoFi Student Loan Refinancing Program

Career development opportunities

Job summary

Prominence Health in Reno, NV is seeking a Lead Claim Specialist to be the first point of contact for the Claims team. You will field inquiries about processing commercial, ASO and Medicare claims to ensure quality service for members, employer groups, brokers, carriers, and provider offices.

This role also aims to promote superior customer service and will identify workflow improvements to increase efficiency and productivity, while providing feedback to the Claims Supervisor on improvements

Qualifications

• Associate’s degree or equivalent experience.
• 3 years of insurance claims processing experience.
• 2 years’ experience with health plans or employer healthcare benefits programs.
• Knowledge of state and federal health insurance regulations.
• Strong customer service and communication skills.

Responsibilities

• Field and answer inquiries about processing commercial, ASO and Medicare claims.
• Promote quality service to health plan members, employer groups, brokers, carriers, and providers.
• Identify workflow improvements to increase efficiency and productivity.
• Provide ongoing feedback to the Claims Supervisor on operations.

Skills

Customer service

Presentation skills

Time management

Analytical

Problem solving

English communication

Microsoft Office

Discretion with confidential data

Education

Associate’s degree

Tools

Microsoft Office Suite

Job description

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary:

The Lead Claim Specialist is the first point of contact for the Claims team. Responsibilities include fielding and answering inquiries about processing commercial, ASO and Medicare claims to ensure quality service is being delivered to health plan members, employer groups, brokers, insurance carriers, and provider offices. This role will also promote quality, superior customer service, and will identify enhancements and changes to workflow processes to increase efficiencies, effectiveness and productivity. Will provide on-going feedback to the Claims Supervisor of what is working and where there are areas of improvement/growth.

Benefit Highlights

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications

Qualifications and Requirements:

• Associate’s degree or equivalent experience
• 3 years of Insurance claims processing experience
• 2 years’ experience working with health plans insurance products or employer healthcare benefits programs
• Knowledge of State and Federal regulations as they pertain to the health insurance industry
• Possesses strong/broad understanding of the claims analyst process, medical/dental terminology, and claims processing procedures
• Superior Customer Service skills --- seeks to understand expectations of internal and external customers. Knows which questions to ask and what information to verify to get to the root cause of a problem
• Ability to communicate clearly and professionally in English, both verbally and in writing with both internal/external customers
• Excellent presentation skills and ability to conduct effective meetings and training sessions
• Strong time management, organizational, analytical, and problem-solving skills
• Intermediate proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook)
• Takes initiative to research, resolve processing and system issues using available resources without direction. Diligently follow-ups with Director, peers, other departments, and customers
• Oriented toward continuous improvement offering ideas and solutions to change or enhance processes or system obstacles; ability to organize and document workflows and processes
• Results orientated with an understanding of where tasks and assignments fall into the big picture and organizes and prioritizes accordingly. Gets more out of few resources
• Must be able to work in environment with shifting priorities and to handle a wide variety of activities and confidential matters with discretion
• The ability to handle confidential or sensitive information with discretion.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.