Senior Claims Specialist

Now is the time to join us!

Who are you

The Senior Claims Specialist will provide exceptional customer service as an onsite liaison reviewing evaluating and authorizing payments for claims under various group health plans. Responsibilities include tracking and reporting potential Workers Comp claims to the carrier. As a Senior Claims Specialist you must accurately adjudicate claims and respond to inquiries in accordance with organizational policies. This role involves interacting with providers carriers plan participants dependents retirees and client contacts.

In this role you will wear many hats but your knowledge will be essential in the following:

• Assist Claims Supervisor with health plan disputes.

• Research benefit coverage issues and reference materials.

• Respond to inquiries from callers walkins or correspondence regarding health plans policies and procedures.

• Coordinating with and educating health plan members on benefits & coverage related to Workers Compensation.

• Coordinate medical records for injury liability.

• Resolve issues and determine necessary actions.

• Educate members on Workers Compensation benefits.

• Coordinate with thirdparty clinics and insurers.

• Prepare correspondence reports and document patient inquiries.

• Ensure claims comply with plan provisions.

• Assists with other duties as assigned within the department or elsewhere on request.

Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• High School Diploma or GED
• Prior experience in a healthcare related field required
• Strong background in customer service with a focus on delivering excellent support and assistance
• 2 plus years experience with medical claims processing experience preferred
• Workers compensation claims experience preferred
• Experience in selffunded plan administrations a plus
• Must be within driving distance of Los Angeles California and willing to work onsite three days a week in an office environment

You also take pride in offering the following Core Skills Competencies and Characteristics:

• Excellent written and verbal communications skills
• Professional telephone presence including excellent listening skills
• Knowledge of medical terminology CPT HCPCS and ICD10 required
• Strong computer skills including familiarity with Microsoft Office tools
• Analytical and problemsolving skills necessary to identify and review pertinent information
• Ability to maintain a very high level of confidentiality
• Able to successfully handle competing priorities
• Proactive team member with attention to detail and follow through

Work schedule: This is a hybrid role based in Los Angeles California requiring onsite work Tuesday Wednesday and Thursday from 8:00 AM to 4:30 PM PST. Remote work is expected on Monday from 8:00 AM to 4:30 PM PST and Friday from 7:00 AM to 3:30 PM PST.

No candidate will meet every single desired qualification. If your experience looks a little different from what weve identified and you think you can bring value to the role wed love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity inclusion equity and social justice.

In compliance with all states and cities that require transparency of pay the base compensation for this position ranges from $23.00 to $27.00. Note that compensation may vary based on location skills and experience. This position is eligible for health dental vision mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity Equity Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level) members clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth #Hybrid

Beware of Hiring Scams:Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications please report them totalent@personifyhealth.com. All of our legitimate openings can be found on the Personify HealthCareer Site.

Application Deadline: Open until position is filled.