Provider Claims Specialist I: Resolve High-Dollar Claims

IEHP; Rancho Cucamonga (CA); Sur place; USD 36 000 - 45 000; Plein temps

Avantages offerts par ce poste

Competitive salary

On-site fitness center

Medical Insurance with Dental and Visa

Life and disability options

Career advancement opportunities

Wellness programs

Flexible Spending Account

CalPERS retirement

457(b) option

Paid life insurance

Pet care insurance

Résumé du poste

Join IEHP as a Claims Specialist I - Provider Claims, responsible for evaluating and processing institutional and professional medical claims under the direction of the Provider Claims Resolution & Recovery Supervisor. Your role includes resolving provider disputes, issuing resolution letters, and processing adjustment requests efficiently to comply with regulations.

We value your dedication to improving our Member's experience and offer numerous perks, including competitive salary, medical

Qualifications

• Minimum of four years of experience with institutional and professional medical claims.
• Proficient in medical claims systems and coding, including ICD-10 and CPT.
• Experience handling provider disputes, appeals, and claim adjustments.

Responsabilités

• Evaluate and process institutional and professional medical claims.
• Resolve provider disputes and appeals, issue resolution letters.
• Ensure compliance with regulatory guidelines.

Connaissances

Claims processing

ICD-10 coding

CPT coding

Analytical skills

Microsoft Office

Interpersonal skills

Data entry

Communication skills

Telephone courtesy

Formation

High School Diploma or GED

Outils

Microsoft Excel

Description du poste

Join IEHP as a Claims Specialist I - Provider Claims, responsible for evaluating and processing institutional and professional medical claims under the direction of the Provider Claims Resolution & Recovery Supervisor. Your role includes resolving provider disputes, issuing resolution letters, and processing adjustment requests efficiently to comply with regulations.

We value your dedication to improving our Member's experience and offer numerous perks, including competitive salary, medical