Inland Empire Health Plan
Lead Claims Processor
Inland Empire Health Plan, San Francisco, California, United States, 94199
Overview
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an
authentic experience!
Under the direction of the Claims Manager and Supervisor, the Lead Claims Processor is responsible for fulfilling the technical support needs of claims processing staff and handling complex claims. This includes but is not limited to; high dollar, dialysis, oncology/chemo, hospital exclusions and claim adjustments in an accurate and expedient manner. Additional duties include assistance with claim inventory control and regulatory audit needs. The Lead Claims Processor has direct communication with other internal and external business units in an effort to resolve claim issues or obtain process clarification.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Additional Benefits
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
CalPERS retirement457(b) option with a contribution matchGenerous paid time off- vacation, holidays, sickState of the art fitness center on-siteMedical Insurance with Dental and VisionPaid life insurance for employees with additional optionsShort-term, and long-term disability optionsPet care insuranceFlexible Spending Account - Health Care/ChildcareWellness programs that promote a healthy work-life balanceCareer advancement opportunities and professional developmentCompetitive salary with annual merit increaseTeam bonus opportunitiesKey Responsibilities
Support claim processing staff with technical questions and business rule clarification.Assist Supervisor with inventory control and compliance monitoring.Coordinate workflow needs relating to regulatory audits.Assist with developing and mentoring of new team members.Assist with the testing of new claim processing procedures.Assist with the development and update of policies and procedures for the claims department.Conduct refresher training of claims staff based on identified error trends.Adjudicate complex professional and institutional claims.Responsible for meeting modified performance measurement standards for productivity and accuracy.Interface with other IEHP business units, vendors, and providers as needed.Assist other business units as directed by Claims SupervisorAdjudication of claim adjustments as assigned.Participate in Claims Department Team Meetings, and other activities as needed.This position provides support to all unit Team Members.
Qualifications
Education & Experience
Minimum of four (4) years of experience in adjudicating inpatient and outpatient professional and institutional medical claimsExperience preferably in an HMO or Managed Care settingMedicare and/or Medi-Cal experience preferredPrior experience in a lead role or customer service environment is a plusHigh School Diploma or GED requiredKey Qualifications
Must have a valid California Driver's licenseAdvanced knowledge of medical claim processing requirementsMicrocomputer skills, proficiency in Windows applications preferred. Excellent communication and interpersonal skills. Strong organizational skills requiredProfessional demeanor
Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location
Telecommute
Pay Range
USD $27.43 - USD $35.66 /Hr.
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an
authentic experience!
Under the direction of the Claims Manager and Supervisor, the Lead Claims Processor is responsible for fulfilling the technical support needs of claims processing staff and handling complex claims. This includes but is not limited to; high dollar, dialysis, oncology/chemo, hospital exclusions and claim adjustments in an accurate and expedient manner. Additional duties include assistance with claim inventory control and regulatory audit needs. The Lead Claims Processor has direct communication with other internal and external business units in an effort to resolve claim issues or obtain process clarification.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Additional Benefits
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
CalPERS retirement457(b) option with a contribution matchGenerous paid time off- vacation, holidays, sickState of the art fitness center on-siteMedical Insurance with Dental and VisionPaid life insurance for employees with additional optionsShort-term, and long-term disability optionsPet care insuranceFlexible Spending Account - Health Care/ChildcareWellness programs that promote a healthy work-life balanceCareer advancement opportunities and professional developmentCompetitive salary with annual merit increaseTeam bonus opportunitiesKey Responsibilities
Support claim processing staff with technical questions and business rule clarification.Assist Supervisor with inventory control and compliance monitoring.Coordinate workflow needs relating to regulatory audits.Assist with developing and mentoring of new team members.Assist with the testing of new claim processing procedures.Assist with the development and update of policies and procedures for the claims department.Conduct refresher training of claims staff based on identified error trends.Adjudicate complex professional and institutional claims.Responsible for meeting modified performance measurement standards for productivity and accuracy.Interface with other IEHP business units, vendors, and providers as needed.Assist other business units as directed by Claims SupervisorAdjudication of claim adjustments as assigned.Participate in Claims Department Team Meetings, and other activities as needed.This position provides support to all unit Team Members.
Qualifications
Education & Experience
Minimum of four (4) years of experience in adjudicating inpatient and outpatient professional and institutional medical claimsExperience preferably in an HMO or Managed Care settingMedicare and/or Medi-Cal experience preferredPrior experience in a lead role or customer service environment is a plusHigh School Diploma or GED requiredKey Qualifications
Must have a valid California Driver's licenseAdvanced knowledge of medical claim processing requirementsMicrocomputer skills, proficiency in Windows applications preferred. Excellent communication and interpersonal skills. Strong organizational skills requiredProfessional demeanor
Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location
Telecommute
Pay Range
USD $27.43 - USD $35.66 /Hr.