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 Company:CalOptima Location:Orange, CA 92868 Status:Full Time, Employee Job Category:Administrative/Clerical Experience:2+ to 5 Years Career Level:Experienced (Non-Manager) Education:High School or equivalent Contact Information Fax:714-246-8581 |
Claims Resolution Specialist
CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. CLAIMS RESOLUTION SPECIALIST The Claims Resolution Specialist will be responsible for following regulatory and internal guidelines in conjunction with CalOptima’s policies and procedures as they apply to adjustment of claims and resolution of reconsideration requests and provider call resolution. Responsibilities include answering provide questions in regard to claims payment and denials, document information in the Facets system, alerting manager of issues that impact production and quality standards. High School graduate or equivalent with three years of experience processing on-line Professional and Facility claims in a managed care environment is highly desirable. Experience processing Medicare or Medi-Cal claims is required. 2-3 years experience handling Provider calls is preferred. CalOptima offers an excellent work environment that includes flexible scheduling plans, a highly competitive benefits package and an organizational mission that drives our employees to excel! |
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