Claims Service Specialist

Sacramento, CA - USA

Hourly Salary: $ 20 - 21

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

Contract

We are recruiting for a Claims Service Specialist to join a healthcare company based in Sacramento. This role is responsible for customer service calls from providers to assist callers as it relates to claims. Ideal candidates will be comfortable answering high volume calls and researching eligibility claim issues. This is a contract position (3-4 months) Monday-Friday 8am-5pm onsite (with potential for hybrid after training and probationary period).

Pay: $20-$21/hour DOE.

PRIMARY RESPONSIBILITIES:

Provide a full range of assistance to providers via telephone or correspondence concerning claims.
Answer telephone in a prompt professional courteous and helpful manner; respond to questions regarding claims status and eligibility inquiries.
Maintain accurate phone calls in the Customer Service Module log.
Demonstrate a comprehensive knowledge of Health Plan Benefits and the various departmental functions.
Analyze and identify concerns/issues and refer to appropriate department as needed.
Evaluate and process claims and claim adjustments in accordance with company policies and procedures according to productivity and quality standards.
Interpret and process routine to moderate claims inquiries.
Check for erroneous items or codes and missing information and correct errors according to established procedures.
Research update and/or adds eligibility to previously entered claims.
Consistently maintain production standards based on transactions/units per hour.
Perform other related duties consistent with the scope and intent of the position.

SKILLS & QUALIFICATIONS:

High School diploma or equivalent required; Associate degree preferred.
One (1) year experience in a healthcare Customer Service Call Center required.
Medical claims experience in managed care claims processing required.
Familiarity with ICD-10 HCPCS CPT coding modifiers DMHC regulations facility and professional claim billing practices.
Ability to maintain production level and quality goals.
Excellent communication skills including both oral and written.
Ability to demonstrate self-motivation multi-task exercise excellent time management follow through on commitments and meet multiple deadlines.
Excellent active listening and critical thinking skills.
Ability to solve entry to mid-level problems with supervision.
Ability to maintain confidentiality and appropriately share information on a need-to-know basis.
Able to pass a drug screen and background check.

Required Experience:

ContractWe are recruiting for a Claims Service Specialist to join a healthcare company based in Sacramento. This role is responsible for customer service calls from providers to assist callers as it relates to claims. Ideal candidates will be comfortable answering high volume calls and researching e...

Contract

Pay: $20-$21/hour DOE.

PRIMARY RESPONSIBILITIES:

Provide a full range of assistance to providers via telephone or correspondence concerning claims.
Answer telephone in a prompt professional courteous and helpful manner; respond to questions regarding claims status and eligibility inquiries.
Maintain accurate phone calls in the Customer Service Module log.
Demonstrate a comprehensive knowledge of Health Plan Benefits and the various departmental functions.
Analyze and identify concerns/issues and refer to appropriate department as needed.
Evaluate and process claims and claim adjustments in accordance with company policies and procedures according to productivity and quality standards.
Interpret and process routine to moderate claims inquiries.
Check for erroneous items or codes and missing information and correct errors according to established procedures.
Research update and/or adds eligibility to previously entered claims.
Consistently maintain production standards based on transactions/units per hour.
Perform other related duties consistent with the scope and intent of the position.

SKILLS & QUALIFICATIONS:

High School diploma or equivalent required; Associate degree preferred.
One (1) year experience in a healthcare Customer Service Call Center required.
Medical claims experience in managed care claims processing required.
Familiarity with ICD-10 HCPCS CPT coding modifiers DMHC regulations facility and professional claim billing practices.
Ability to maintain production level and quality goals.
Excellent communication skills including both oral and written.
Ability to demonstrate self-motivation multi-task exercise excellent time management follow through on commitments and meet multiple deadlines.
Excellent active listening and critical thinking skills.
Ability to solve entry to mid-level problems with supervision.
Ability to maintain confidentiality and appropriately share information on a need-to-know basis.
Able to pass a drug screen and background check.

Required Experience:

Key Skills

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IT Sales and Marketing
Civil Quality Control
Activex
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About Company

Pacific Temporary Services

Pacific Staffing in Sacramento, one of the top Sacramento staffing agencies, provides temporary staffing, recruiting and employment services in Sacramento and beyond.

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