We have an opportunity to join the Alliance as a Claims Customer Service Representative in the Claims Department.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Claims Manager, this position:
- Will act as a frontline customer service representative and research, resolves, and responds to inquiries regarding claims issues from providers and Alliance staff
- Process various claim types and conducts research and analysis related to claims resolution
- Maintain current knowledge of claims processes, procedures, and related documentation, assists in developing and maintaining internal operating procedures, and recommends coding and reimbursement changes in the Alliance’s claims processing system
ABOUT THE TEAM
Claims strives to accurately process all claims in a timely manner, respectfully respond to all Provider inquiries, engage, and interact with all Alliance colleagues in a respectful and collaborative way, and foster an environment of learning and continuous improvement. We are a tight-knit team who supports Alliance members' access to care by ensuring medical services are paid to network providers accurately and on time.
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here.
- Knowledge of:
- Methods and techniques of medical claims processing
- General administrative procedures and standard business office practices
- Principles and practices of customer service
- Medical insurance Explanation of Benefits
- Ability to:
- Perform extensive phone work in a professional manner
- Ensure high administrative and customer service quality
- Process claim data of all claims types comprehensively, accurately and efficiently
- Conduct research, gather and interpret information and data, identify issues of concern, and make logical recommendations for action
- Education and Experience:
- High School Diploma or equivalent and two years (or an Associate’s degree and a minimum of one year) of relevant experience processing claims in a Medi-Cal health plan or managed care environment; or a combination of education and relevant work experience may be qualifying
OTHER INFORMATION
- We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
- While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
- In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
OUR BENEFITS
Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 12 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- Onsite EV Charging Stations
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
