Senior Claims Specialist, Managed Care Adjudication

Providence; Renton (WA); Hybride; USD 53 000 - 83 000; Plein temps

Avantages offerts par ce poste

Competitive pay

Best-in-class benefits – medical, d+d,

401(k) plan with employer matching

Generous paid time off

Tuition reimbursement & student loan

Wellness & mental health assistance

Back-up child & elder care

Voluntary benefits

Résumé du poste

Providence is seeking a Senior Claims Specialist for the USFHP program in Renton, WA. This full-time, hybrid role adjudicates outside-service claims for capitated members and handles complex adjustments to support processing needs.

You will respond to customer service requests, manage workflow for the line of business, and serve as a leading resource in at least one specialty area such as EDI, health plan repricing, or HPR. Our team champions patient-focused care and professional development.

Qualifications

• 4 years in Managed Care operations with at least 3 years claims processing experience in a TPA, MSO, HMO, PHO or large group setting.
• Experience supporting administration of managed care products.
• Familiarity with IDX healthcare software.
• Knowledge of CHAMPUS, Medicare and/or Medicaid benefits/programs.
• Experience across all areas of specialty claim processing (COB, Adjustments, POS, Home Health, Home Infusion, etc.).

Responsabilités

• Adjudicates all claims submitted by outside services for PMC's capitated population.
• Adjusts complex claims for advanced processing needs.
• Responds to Customer Service Requests and resolves problematic claims.
• Manages workflow for assigned Line of Business.
• Serves as primary department resource for at least one major area (EDI, Repricing, or HPR).

Connaissances

Managed Care operations

Claims processing

Healthcare knowledge

Problem solving

Communication

Formation

Bachelor's Degree or equivalent in Health Care Business Administration

Outils

IDX healthcare software

Description du poste

Providence is seeking a Senior Claims Specialist for the USFHP program in Renton, WA. This full-time, hybrid role adjudicates outside-service claims for capitated members and handles complex adjustments to support processing needs.

You will respond to customer service requests, manage workflow for the line of business, and serve as a leading resource in at least one specialty area such as EDI, health plan repricing, or HPR. Our team champions patient-focused care and professional development.