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Providence
Providence
H1B Visa SponsorConsultingHealthcareInsurance
Providence is a not-for-profit health system providing a broad range of healthcare services, from primary and urgent care to pediatrics, maternity care, cancer treatment, neurosurgery, and orthopedics. Its care network combines in-person services with virtual appointments and mobile-app access, helping patients connect with providers in ways that fit their needs. Guided by a focus on compassion, dignity, justice, and service to vulnerable communities, Providence also supports healthcare research and innovation through initiatives such as genomic profiling and clinical trials. The organization brings together clinical, operational, technology, and research teams working to improve patient outcomes and expand access to care.
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Senior Claims Processing Specialist

Lead audits, compliance, and training across Providence’s healthcare claims operations. Coordinate with health plans, providers, patients, hospitals, and adjudication teams.

USUnited StatesCACalifornia
$27 – $42 / hour
RemoteFull-timeSeniorEnglish RequiredClaims Specialist

Description

  • Oversee internal audits of adjudicated claims and encounters.
  • Check payment runs for accuracy.
  • Create policies and procedures for recurring claims audits.
  • Maintain compliance with health plans, client groups, and administrative contract terms.
  • Develop and lead claims training programs.
  • Update training to reflect changes in policies, procedures, and technology.
  • Promote provider and vendor satisfaction while protecting operational integrity.
  • Coordinate between contracted health plans, patients, hospitals, and the IT department.
  • Provide daily claims compliance guidance and training to Claims Examiners and Adjudication teams.
  • Meet customer-defined quality and responsiveness standards.

Requirements

  • At least five years of professional and facility claims processing experience.
  • Familiarity with applicable state and federal laws governing claim payment and denial timelines.
  • Familiarity with state and federal timeliness compliance rules and regulations.
  • Knowledge of the Provider Dispute Resolution tracking mechanism (AB1455).

Benefits

  • 401(k) retirement savings plan with employer matching.
  • Medical, dental, and vision coverage.
  • Life insurance.
  • Disability insurance.
  • Paid parental leave.
  • Vacation and holiday leave.
  • Time off for health issues.
  • Voluntary benefits.
  • Well-being resources.
  • Additional compensation may include shift differentials, standby or on-call pay, overtime, premiums, extra-shift incentives, or bonuses.

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