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IEHP
IEHP
1 001 – 5 000 Darbuotojai
DraudimasKonsultavimasLogistika
IEHP yra regioninis sveikatos draudimo planas, aptarnaujantis mažas pajamas gaunančius asmenis ir šeimas Riversaido bei San Bernardino apygardose. 1995 m. įkurta organizacija teikia draudimo apsaugą per tokias programas kaip „Medi-Cal“, „DualChoice“ ir „Covered California“, bendradarbiauja su vietos gydytojais ir sveikatos priežiūros įstaigomis, kad sujungtų narius su medicinos paslaugomis. Bendruomeniškas požiūris taip pat apima psichikos sveikatos palaikymą, fizinio aktyvumo programas ir sveikatingumo švietimą.
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Claims Specialist I, Provider Claims (California Remote)

Evaluate and resolve provider medical claims for Inland Empire Health Plan, including coverage and payment decisions, disputes, appeals, and adjustments.

USJungtinės ValstijosCAKalifornija
25 $ – 33 $ / valanda
NuotolinisVisas etatasVidutinis lygisVyresnysis specialistasPrivaloma Kalba: anglųDraudimo žalų specialistas

Aprašymas

  • Review professional and institutional claims, including high-dollar and outpatient and inpatient claims
  • Determine coverage and payment levels
  • Resolve provider disputes and appeals
  • Prepare resolution letters
  • Process claim adjustment requests accurately and on time under standard procedures and regulatory guidelines
  • Contribute to payment adjustment projects
  • Manage complex claims as assigned
  • Support IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA accreditation

Reikalavimai

  • Bring at least four years of experience evaluating and processing institutional and professional medical claims
  • Be proficient with medical claims systems, ICD-10 and CPT coding, medical authorization review, provider contract rate interpretation, and medical benefit coverage decisions
  • Have prior experience managing provider disputes, appeals, and claim adjustments
  • Experience in an HMO or managed care setting is preferred
  • Medicare and/or Medi-Cal experience is preferred
  • Experience in a managed care or government payer environment is helpful
  • Have a high school diploma or GED
  • Understand claims operations and customer service standards
  • Know ICD-9, ICD-10, CPT, and HCPC coding and general claims processing practices
  • Demonstrate strong analytical and problem-solving skills
  • Be proficient with Microsoft Office and advanced Microsoft Excel
  • Have strong written communication skills
  • Be able to analyze data and interpret regulatory requirements
  • Have excellent communication and interpersonal skills, strong organization, and data entry skills
  • Type at least 45 words per minute
  • Have excellent oral and written communication skills
  • Build effective working relationships across the organization
  • Maintain a professional demeanor
  • Show telephone courtesy and patience.
  • State-of-the-art onsite fitness center
  • Medical, dental, and vision insurance coverage

Privalumai

  • State-of-the-art onsite fitness center
  • Medical, dental, and vision insurance
  • Life insurance and short- and long-term disability options
  • Career advancement and professional development opportunities
  • Wellness programs supporting work-life balance
  • Flexible Spending Account for health care and childcare
  • CalPERS retirement plan
  • 457(b) plan with employer contribution match
  • Employer-paid life insurance
  • Pet care insurance

Susiję darbai

AT&T

AT&T Business Sales Representative, Territory Accounts — Memphis

AT&T
H1B vizos rėmėjasTechnologijos ir inovacijosTelekomunikacijos
USJungtinės ValstijosTNTenesis
38 800 $ – 58 200 $ / metai
Darbas vietojeVisas etatasJaunesnysis specialistasVidutinis lygisDiplomas nebūtinasPrivaloma Kalba: anglųPardavimai

Build AT&T’s Memphis small-business and mid-market customer base by selling fiber broadband and other communications solutions. The role combines prospecting, account development, and consultative selling to grow territory revenue.

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