We are recruiting for a Claims Service Specialist for 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, Monday-Friday, 8am-5pm. Pay: $17-$18/hour DOE. 

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.

QUALIFICATIONS:

• High School diploma or equivalent required; Associate degree preferred.

• One (1) year experience in a Customer Service Call Center required.

• Claims experience in managed care claims processing preferred.

• Familiarity with ICD-9/10, 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.

• Intermediate proficiency in Microsoft software (Word, Excel, PowerPoint).