Claims Customer Service Representative

Claims Customer Service Representative

Location : Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California;

Santa Cruz County, California

Accepting applications through Tuesday, October 8, 2024 by 5 : 00 pm.

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 - Provider Support this position :

• Acts as a frontline customer service representative and researches, resolves, and responds to inquiries regarding claims issues from providers and Alliance staff
• Processes various claim types and conducts research and analysis related to claims resolution
• Maintains 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

We handle billing-related inquiries and issues from providers concerning treatment, services and care of our members.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here .

• Knowledge of :
• The methods and techniques of medical claims processing
• Administrative procedures and standard business office practices and equipment
• The principles and practices of customer service
• Medical insurance Explanation of Benefits
• Medi-Cal and prepaid health programs
• Ability to :
• Effectively and clearly document, summarize and resolve concerns and inquiries related to claims issues and recognize those issues requiring escalation to a higher-level staff member
• Gather and evaluate information, ask appropriate questions and utilize problem solving skills
• Utilize a variety of computer systems, including the Alliance information system and external websites and databases
• Demonstrate strong organizational skills and attention to detail
• Perform extensive phone work in a professional manner and meet productivity and quality standards for calls
• Education and Experience :
• High School Diploma or equivalent
• Minimum of two years of experience performing claims processing in a Medi-Cal or managed care environment (an Associate's degree may substitute for one year of the required experience);

or an equivalent combination of education and 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).

Zone 1 (Monterey, San Benito and Santa Cruz)

$26.54 - $42.47 USD

Zone 2 (Mariposa and Merced)

$24.15 - $38.65 USD

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.