Remote Claims Adjustment & Dispute Specialist

Automatic Data Processing, Inc.; French Camp (CA); A distancia; USD 52.000 - 70.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Wellness program

Dental & vision

PTO + holidays

Retirement plan

FSAs

Life and AD&D insurance

Disability insurance

EAP

Health advocacy

Remote-friendly

Descripción de la vacante

Health Plan of San Joaquin seeks a Claims Adjustment and Dispute Specialist in California to oversee disputes and adjustment requests under minimal supervision. You will review provider disputes, verify payment histories, and communicate outcomes while maintaining accuracy and efficiency in claims processing.

The role emphasizes knowledge of Medi-Cal regulations, coding basics, and policy understandings, with strong communication and teamwork to support our members.

Formación

• Basic knowledge of Medi-Cal regulations as they relate to claims processing.
• Basic knowledge of procedure coding and medical terminology in claims.
• Deep knowledge of medical policy benefits and exclusions.
• Deep knowledge of industry standard payment practices.
• Deep knowledge of HPSJ systems as they relate to claims processing.
• Produces accurate and complete work.
• Manages workload to produce appropriate output.
• Learns through experimentation and improves processes.
• Maintains confidentiality and professional discretion.
• Strong English communication and documentation skills.

Responsabilidades

• Research, resolve, and complete disputes and adjustment requests.
• Review provider disputes, payment history, and send required correspondence.
• Assess call logs and reassign as needed to other departments.
• Identify claim error patterns and escalate.
• Review, reseach, and reprocess assigned claims.

Conocimientos

Interpersonal skills

Oral & written communication

Teamwork

English proficiency

Problem solving

Time management

Analytical thinking

Adaptability

Continuous improvement

Confidentiality

Educación

High school diploma or GED

1 year as analyst I or equivalent

QNEX experience

Associate’s degree (preferred)

Herramientas

Windows

Excel

Word

Outlook

Descripción del empleo

Health Plan of San Joaquin seeks a Claims Adjustment and Dispute Specialist in California to oversee disputes and adjustment requests under minimal supervision. You will review provider disputes, verify payment histories, and communicate outcomes while maintaining accuracy and efficiency in claims processing.

The role emphasizes knowledge of Medi-Cal regulations, coding basics, and policy understandings, with strong communication and teamwork to support our members.