Claims Customer Service Representative I

Profile

We have an opportunity to join the Alliance as a Claims Customer Service Representative I in the Claims Department.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Claims Manager - Provider Support, you will research, resolve and respond to provider and Alliance staff inquiries on claims issues. You will process various claim types and conduct research and analysis on projects related to claims resolution. You will maintain current knowledge of claims processes, procedures and related documentation, assist in identifying and maintaining internal operating procedures, and recommend coding and reimbursement changes in the Alliance’s claims processing program.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here

Knowledge of:

General administrative procedures and standard business office practices

Principles and practices of customer service

medical insurance Explanation of Benefits

Ability to:

Perform extensive phone work in a professional manner

Ensure high administrative and customer service quality

Process claim data of all claims types comprehensively, accurately and efficiently

Conduct research, gather and interpret information and data, identify issues of concern, and make logical recommendations for action

Education and Experience:

High School Diploma or equivalent and two years (or an Associate’s degree and a minimum of one year) of relevant experience processing claims in a Medi-Cal health plan or managed care environment; or a combination of education and relevant work experience may be qualifying

OTHER DETAILS

While this position is connected to one of our Alliance offices, we are in hybrid telecommute work environment right now and we anticipate that the interview process will take place remotely.

Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.

Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.

COVID-19 Vaccine Requirement:

This position requires staff to be fully vaccinated and boosted upon their start date as a condition of employment. Proof of vaccination must be submitted at time of hire. Fully vaccinated is defined as receipt of the second dose in a 2-dose series (ex: Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (ex: Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose.

Additionally, all positions at the Alliance are required to meet these minimum qualifications.

OUR BENEFITS

Medical, Dental and Vision Plans

Ample Paid Time Off

11 Paid Holidays per year

401(a) Retirement Plan

457 Deferred Compensation Plan

Robust Health and Wellness Program

EV Charging Stations

And many more

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Merced, Monterey and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Company info

Central California Alliance for Health
Website : http://www.ccah-alliance.org/