Claims Analyst jobs at East Alabama Health - 71 jobs
Claims Analyst Credits Corrections - Eamc Business Office
East Alabama Hospital 4.1
Claims analyst job at East Alabama Health
EAMC MISSION
At East Alabama Medical Center, our mission is high quality, compassionate health care, and that statement guides everything we do. We set high standards for customer service, quality, and keeping costs under control.
POSITION SUMMARY
The ClaimsAnalyst for Credits is responsible for accurately and compliantly filing credit balance reports. This includes working various reports and queues, working insurance credit balances and self-pay credit balances, working correspondence from insurance carriers, staff members and other departments.
POSITION QUALIFICATIONS
Minimum Education
High School Diploma or equivalent required
Minimum Experience
1 year of experience
Required Registration/License/Certification
N/A
Preferred Education
Associates Degree or Higher
Preferred Experience
2 or more years of Healthcare Related Experience
Preferred Registration/License/Certification
N/A
Other Requirements
N/A
$24k-51k yearly est. 60d+ ago
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Stop Loss Claims Analyst
Cambia Health 3.9
Tacoma, WA jobs
Stop Loss ClaimsAnalysts Work from home within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia's dedicated team of Stop Loss ClaimsAnalysts is living our mission to make health care easier and lives better. As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - all in service of creating a person-focused health care experience.
Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Stop Loss ClaimsAnalyst would have a/an High School Diploma or GED and 5 years of professional claims processing experience or equivalent combination of education and experience.
Skills and Attributes:
* Knowledge of when to utilize legal and clinical resources to comprehend legal and medical terminology in order to make final determinations on whether to approve or further investigate a claim.
* Possess strong knowledge of Policy and Contract terms, lasering, aggregating deductibles and eligibility to ensure correct processing of all eligible claim reimbursements.
* Advanced knowledge of claim reserving and settlement.
* Excellent communication skills for both external and internal customers
* Demonstrate understanding of medical terminology and ICD-10/CPT coding.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
What You Will Do at Cambia:
* Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. Recognize all policies and procedures that apply to claim and be able to quickly reference documentation for details.
* Make informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information.
* Lead the process to measure, track, and report all aggregate claims.
* Audit all aggregate claims onsite and off-site when needed based on set dollar threshold. Provide client audit reporting as needed.
* Manage inventory of claims while ensuring best practices and claim standards are met.
* Identify new opportunities to track and process claims more efficiently. Thoroughly document claims throughout the adjudication process so they can be understood by the team and for audit purposes.
* Analyze and investigate all claims, request supplementary documentation as necessary, in order to process or reprocess claims in a timely and accurate manner.
Work Environment
* No unusual working conditions.
* Work is primarily performed in an office environment.
The expected hiring range for a Stop Loss ClaimsAnalyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 6.25%. The current full salary range for this role is $64,000.00 to $106,000.00.
#LI-remote
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
* Work alongside diverse teams building cutting-edge solutions to transform health care.
* Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
* Grow your career with a company committed to helping you succeed.
* Give back to your community by participating in Cambia-supported outreach programs.
* Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
* Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
* Annual employer contribution to a health savings account.
* Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
* Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
* Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
* Award-winning wellness programs that reward you for participation.
* Employee Assistance Fund for those in need.
* Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email ******************************. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
$68.9k-93.2k yearly Auto-Apply 29d ago
Stop Loss Claims Analyst
Cambia Health 3.9
Yakima, WA jobs
Stop Loss ClaimsAnalysts Work from home within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia's dedicated team of Stop Loss ClaimsAnalysts is living our mission to make health care easier and lives better. As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - all in service of creating a person-focused health care experience.
Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Stop Loss ClaimsAnalyst would have a/an High School Diploma or GED and 5 years of professional claims processing experience or equivalent combination of education and experience.
Skills and Attributes:
* Knowledge of when to utilize legal and clinical resources to comprehend legal and medical terminology in order to make final determinations on whether to approve or further investigate a claim.
* Possess strong knowledge of Policy and Contract terms, lasering, aggregating deductibles and eligibility to ensure correct processing of all eligible claim reimbursements.
* Advanced knowledge of claim reserving and settlement.
* Excellent communication skills for both external and internal customers
* Demonstrate understanding of medical terminology and ICD-10/CPT coding.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
What You Will Do at Cambia:
* Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. Recognize all policies and procedures that apply to claim and be able to quickly reference documentation for details.
* Make informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information.
* Lead the process to measure, track, and report all aggregate claims.
* Audit all aggregate claims onsite and off-site when needed based on set dollar threshold. Provide client audit reporting as needed.
* Manage inventory of claims while ensuring best practices and claim standards are met.
* Identify new opportunities to track and process claims more efficiently. Thoroughly document claims throughout the adjudication process so they can be understood by the team and for audit purposes.
* Analyze and investigate all claims, request supplementary documentation as necessary, in order to process or reprocess claims in a timely and accurate manner.
Work Environment
* No unusual working conditions.
* Work is primarily performed in an office environment.
The expected hiring range for a Stop Loss ClaimsAnalyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 6.25%. The current full salary range for this role is $64,000.00 to $106,000.00.
#LI-remote
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
* Work alongside diverse teams building cutting-edge solutions to transform health care.
* Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
* Grow your career with a company committed to helping you succeed.
* Give back to your community by participating in Cambia-supported outreach programs.
* Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
* Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
* Annual employer contribution to a health savings account.
* Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
* Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
* Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
* Award-winning wellness programs that reward you for participation.
* Employee Assistance Fund for those in need.
* Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email ******************************. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
$68.9k-93.2k yearly Auto-Apply 29d ago
Stop Loss Claims Analyst
Cambia Health 3.9
Renton, WA jobs
Stop Loss ClaimsAnalysts Work from home within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia's dedicated team of Stop Loss ClaimsAnalysts is living our mission to make health care easier and lives better. As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - all in service of creating a person-focused health care experience.
Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Stop Loss ClaimsAnalyst would have a/an High School Diploma or GED and 5 years of professional claims processing experience or equivalent combination of education and experience.
Skills and Attributes:
* Knowledge of when to utilize legal and clinical resources to comprehend legal and medical terminology in order to make final determinations on whether to approve or further investigate a claim.
* Possess strong knowledge of Policy and Contract terms, lasering, aggregating deductibles and eligibility to ensure correct processing of all eligible claim reimbursements.
* Advanced knowledge of claim reserving and settlement.
* Excellent communication skills for both external and internal customers
* Demonstrate understanding of medical terminology and ICD-10/CPT coding.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
What You Will Do at Cambia:
* Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. Recognize all policies and procedures that apply to claim and be able to quickly reference documentation for details.
* Make informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information.
* Lead the process to measure, track, and report all aggregate claims.
* Audit all aggregate claims onsite and off-site when needed based on set dollar threshold. Provide client audit reporting as needed.
* Manage inventory of claims while ensuring best practices and claim standards are met.
* Identify new opportunities to track and process claims more efficiently. Thoroughly document claims throughout the adjudication process so they can be understood by the team and for audit purposes.
* Analyze and investigate all claims, request supplementary documentation as necessary, in order to process or reprocess claims in a timely and accurate manner.
Work Environment
* No unusual working conditions.
* Work is primarily performed in an office environment.
The expected hiring range for a Stop Loss ClaimsAnalyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 6.25%. The current full salary range for this role is $64,000.00 to $106,000.00.
#LI-remote
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
* Work alongside diverse teams building cutting-edge solutions to transform health care.
* Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
* Grow your career with a company committed to helping you succeed.
* Give back to your community by participating in Cambia-supported outreach programs.
* Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
* Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
* Annual employer contribution to a health savings account.
* Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
* Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
* Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
* Award-winning wellness programs that reward you for participation.
* Employee Assistance Fund for those in need.
* Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email ******************************. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
$68.9k-93.2k yearly Auto-Apply 29d ago
Stop Loss Claims Analyst
Cambia Health 3.9
Spokane, WA jobs
Stop Loss ClaimsAnalysts Work from home within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia's dedicated team of Stop Loss ClaimsAnalysts is living our mission to make health care easier and lives better. As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - all in service of creating a person-focused health care experience.
Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Stop Loss ClaimsAnalyst would have a/an High School Diploma or GED and 5 years of professional claims processing experience or equivalent combination of education and experience.
Skills and Attributes:
* Knowledge of when to utilize legal and clinical resources to comprehend legal and medical terminology in order to make final determinations on whether to approve or further investigate a claim.
* Possess strong knowledge of Policy and Contract terms, lasering, aggregating deductibles and eligibility to ensure correct processing of all eligible claim reimbursements.
* Advanced knowledge of claim reserving and settlement.
* Excellent communication skills for both external and internal customers
* Demonstrate understanding of medical terminology and ICD-10/CPT coding.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
What You Will Do at Cambia:
* Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. Recognize all policies and procedures that apply to claim and be able to quickly reference documentation for details.
* Make informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information.
* Lead the process to measure, track, and report all aggregate claims.
* Audit all aggregate claims onsite and off-site when needed based on set dollar threshold. Provide client audit reporting as needed.
* Manage inventory of claims while ensuring best practices and claim standards are met.
* Identify new opportunities to track and process claims more efficiently. Thoroughly document claims throughout the adjudication process so they can be understood by the team and for audit purposes.
* Analyze and investigate all claims, request supplementary documentation as necessary, in order to process or reprocess claims in a timely and accurate manner.
Work Environment
* No unusual working conditions.
* Work is primarily performed in an office environment.
The expected hiring range for a Stop Loss ClaimsAnalyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 6.25%. The current full salary range for this role is $64,000.00 to $106,000.00.
#LI-remote
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
* Work alongside diverse teams building cutting-edge solutions to transform health care.
* Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
* Grow your career with a company committed to helping you succeed.
* Give back to your community by participating in Cambia-supported outreach programs.
* Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
* Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
* Annual employer contribution to a health savings account.
* Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
* Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
* Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
* Award-winning wellness programs that reward you for participation.
* Employee Assistance Fund for those in need.
* Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email ******************************. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
$68.9k-93.2k yearly Auto-Apply 29d ago
Stop Loss Claims Analyst
Cambia Health 3.9
Vancouver, WA jobs
Stop Loss ClaimsAnalysts Work from home within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia's dedicated team of Stop Loss ClaimsAnalysts is living our mission to make health care easier and lives better. As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - all in service of creating a person-focused health care experience.
Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Stop Loss ClaimsAnalyst would have a/an High School Diploma or GED and 5 years of professional claims processing experience or equivalent combination of education and experience.
Skills and Attributes:
* Knowledge of when to utilize legal and clinical resources to comprehend legal and medical terminology in order to make final determinations on whether to approve or further investigate a claim.
* Possess strong knowledge of Policy and Contract terms, lasering, aggregating deductibles and eligibility to ensure correct processing of all eligible claim reimbursements.
* Advanced knowledge of claim reserving and settlement.
* Excellent communication skills for both external and internal customers
* Demonstrate understanding of medical terminology and ICD-10/CPT coding.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
What You Will Do at Cambia:
* Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. Recognize all policies and procedures that apply to claim and be able to quickly reference documentation for details.
* Make informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information.
* Lead the process to measure, track, and report all aggregate claims.
* Audit all aggregate claims onsite and off-site when needed based on set dollar threshold. Provide client audit reporting as needed.
* Manage inventory of claims while ensuring best practices and claim standards are met.
* Identify new opportunities to track and process claims more efficiently. Thoroughly document claims throughout the adjudication process so they can be understood by the team and for audit purposes.
* Analyze and investigate all claims, request supplementary documentation as necessary, in order to process or reprocess claims in a timely and accurate manner.
Work Environment
* No unusual working conditions.
* Work is primarily performed in an office environment.
The expected hiring range for a Stop Loss ClaimsAnalyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 6.25%. The current full salary range for this role is $64,000.00 to $106,000.00.
#LI-remote
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
* Work alongside diverse teams building cutting-edge solutions to transform health care.
* Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
* Grow your career with a company committed to helping you succeed.
* Give back to your community by participating in Cambia-supported outreach programs.
* Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
* Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
* Annual employer contribution to a health savings account.
* Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
* Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
* Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
* Award-winning wellness programs that reward you for participation.
* Employee Assistance Fund for those in need.
* Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email ******************************. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
$68.9k-93.2k yearly Auto-Apply 29d ago
Stop Loss Claims Analyst
Cambia Health 3.9
Washington jobs
Stop Loss ClaimsAnalysts Work from home within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia's dedicated team of Stop Loss ClaimsAnalysts is living our mission to make health care easier and lives better. As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - all in service of creating a person-focused health care experience.
Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Stop Loss ClaimsAnalyst would have a/an High School Diploma or GED and 5 years of professional claims processing experience or equivalent combination of education and experience.
Skills and Attributes:
* Knowledge of when to utilize legal and clinical resources to comprehend legal and medical terminology in order to make final determinations on whether to approve or further investigate a claim.
* Possess strong knowledge of Policy and Contract terms, lasering, aggregating deductibles and eligibility to ensure correct processing of all eligible claim reimbursements.
* Advanced knowledge of claim reserving and settlement.
* Excellent communication skills for both external and internal customers
* Demonstrate understanding of medical terminology and ICD-10/CPT coding.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
What You Will Do at Cambia:
* Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. Recognize all policies and procedures that apply to claim and be able to quickly reference documentation for details.
* Make informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information.
* Lead the process to measure, track, and report all aggregate claims.
* Audit all aggregate claims onsite and off-site when needed based on set dollar threshold. Provide client audit reporting as needed.
* Manage inventory of claims while ensuring best practices and claim standards are met.
* Identify new opportunities to track and process claims more efficiently. Thoroughly document claims throughout the adjudication process so they can be understood by the team and for audit purposes.
* Analyze and investigate all claims, request supplementary documentation as necessary, in order to process or reprocess claims in a timely and accurate manner.
Work Environment
* No unusual working conditions.
* Work is primarily performed in an office environment.
The expected hiring range for a Stop Loss ClaimsAnalyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 6.25%. The current full salary range for this role is $64,000.00 to $106,000.00.
#LI-remote
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
* Work alongside diverse teams building cutting-edge solutions to transform health care.
* Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
* Grow your career with a company committed to helping you succeed.
* Give back to your community by participating in Cambia-supported outreach programs.
* Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
* Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
* Annual employer contribution to a health savings account.
* Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
* Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
* Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
* Award-winning wellness programs that reward you for participation.
* Employee Assistance Fund for those in need.
* Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email ******************************. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
$68.9k-93.2k yearly Auto-Apply 29d ago
Benefit and Claims Analyst
Highmark Health 4.5
Montgomery, AL jobs
This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements.
**ESSENTIAL RESPONSIBILITIES**
+ Coordinate, analyze, and interpret the benefits and claims processes for the department.
+ Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties.
+ Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations.
+ Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes.
+ Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines.
+ Monitor and identify claim processing inaccuracies. Bring trends to the attention of management.
+ Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication.
+ Work independently of support, frequently utilizing resources to resolve customer inquiries.
+ Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants.
+ Gather information and develop presentation/training materials for support and education.
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ High School or GED
**Substitutions**
+ None
**Preferred**
+ Associate's degree in or equivalent training in Business or a related field
**EXPERIENCE**
**Required**
+ 3 years of customer service, health insurance benefits and claims experience.
+ Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies
+ PC Proficiency including Microsoft Office Products
+ Ability to communicate effectively in both verbal and written form with all levels of employees
**Preferred**
+ Working knowledge of medical procedures and terminology.
+ Complex claim workflow analysis and adjudication.
+ ICD9, CPT, HPCPS coding knowledge/experience.
+ Knowledge of Medicare and Medicaid policies
**LICENSES or CERTIFICATIONS**
**Required**
+ None
**Preferred**
+ None
**SKILLS**
+ Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services
+ Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures
+ The ability to take direction, to navigate through multiple systems simultaneously
+ The ability to interact well with peers, supervisors and customers
+ Understanding the implications of new information for both current and future problem-solving and decision-making
+ Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times
+ Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems
+ Ability to solve complex issues on multiple levels.
+ Ability to solve problems independently and creatively.
+ Ability to handle many tasks simultaneously and respond to customers and their issues promptly.
**Language (Other than English):**
None
**Travel Requirement:**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$21.53
**Pay Range Maximum:**
$32.30
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J273827
$21.5-32.3 hourly 31d ago
Senior Stop Loss Claims Analyst - HNAS
Highmark Health 4.5
Montgomery, AL jobs
This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards.
HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve.
**ESSENTIAL RESPONSIBILITIES**
+ Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs.
+ Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards.
+ Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable.
+ Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template.
+ Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation.
+ Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures.
+ Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization.
+ Maintains accurate claim records.
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ High School Diploma/GED
**Substitutions**
+ None
**Preferred**
+ Bachelor's degree
**EXPERIENCE**
**Required**
+ 5 years of relevant, progressive experience in health insurance claims
+ 3 years of prior experience processing 1st dollar health insurance claims
+ 3 years of experience with medical terminology
**Preferred:**
+ 3 years of experience in a Stop Loss ClaimsAnalyst role.
**SKILLS**
+ Ability to communicate concise accurate information effectively.
+ Organizational skills
+ Ability to manage time effectively.
+ Ability to work independently.
+ Problem Solving and analytical skills.
**Language (Other than English):**
None
**Travel Requirement:**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$22.71
**Pay Range Maximum:**
$35.18
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J273755
$22.7-35.2 hourly 27d ago
Benefit and Claims Analyst
Highmark Health 4.5
Olympia, WA jobs
This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements.
**ESSENTIAL RESPONSIBILITIES**
+ Coordinate, analyze, and interpret the benefits and claims processes for the department.
+ Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties.
+ Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations.
+ Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes.
+ Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines.
+ Monitor and identify claim processing inaccuracies. Bring trends to the attention of management.
+ Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication.
+ Work independently of support, frequently utilizing resources to resolve customer inquiries.
+ Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants.
+ Gather information and develop presentation/training materials for support and education.
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ High School or GED
**Substitutions**
+ None
**Preferred**
+ Associate's degree in or equivalent training in Business or a related field
**EXPERIENCE**
**Required**
+ 3 years of customer service, health insurance benefits and claims experience.
+ Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies
+ PC Proficiency including Microsoft Office Products
+ Ability to communicate effectively in both verbal and written form with all levels of employees
**Preferred**
+ Working knowledge of medical procedures and terminology.
+ Complex claim workflow analysis and adjudication.
+ ICD9, CPT, HPCPS coding knowledge/experience.
+ Knowledge of Medicare and Medicaid policies
**LICENSES or CERTIFICATIONS**
**Required**
+ None
**Preferred**
+ None
**SKILLS**
+ Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services
+ Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures
+ The ability to take direction, to navigate through multiple systems simultaneously
+ The ability to interact well with peers, supervisors and customers
+ Understanding the implications of new information for both current and future problem-solving and decision-making
+ Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times
+ Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems
+ Ability to solve complex issues on multiple levels.
+ Ability to solve problems independently and creatively.
+ Ability to handle many tasks simultaneously and respond to customers and their issues promptly.
**Language (Other than English):**
None
**Travel Requirement:**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$21.53
**Pay Range Maximum:**
$32.30
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J273827
$21.5-32.3 hourly 31d ago
Senior Stop Loss Claims Analyst - HNAS
Highmark Health 4.5
Olympia, WA jobs
This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards.
HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve.
**ESSENTIAL RESPONSIBILITIES**
+ Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs.
+ Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards.
+ Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable.
+ Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template.
+ Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation.
+ Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures.
+ Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization.
+ Maintains accurate claim records.
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ High School Diploma/GED
**Substitutions**
+ None
**Preferred**
+ Bachelor's degree
**EXPERIENCE**
**Required**
+ 5 years of relevant, progressive experience in health insurance claims
+ 3 years of prior experience processing 1st dollar health insurance claims
+ 3 years of experience with medical terminology
**Preferred:**
+ 3 years of experience in a Stop Loss ClaimsAnalyst role.
**SKILLS**
+ Ability to communicate concise accurate information effectively.
+ Organizational skills
+ Ability to manage time effectively.
+ Ability to work independently.
+ Problem Solving and analytical skills.
**Language (Other than English):**
None
**Travel Requirement:**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$22.71
**Pay Range Maximum:**
$35.18
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J273755
$22.7-35.2 hourly 27d ago
BCBS Claims Specialist II
Healthcare Management Administrators 4.0
Bellevue, WA jobs
HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.
We are proud to say that for three years, HMA has been chosen as a ‘Washington's Best Workplaces' by our Staff and PSBJ™. Our vision, ‘Proving What's Possible in Healthcare™,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.
What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven.
What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: *****************
How YOU will make a Difference:
As a Claims Specialist, you'll be at the heart of our mission to deliver exceptional service. Working alongside a dedicated team, you'll ensure the accurate and timely processing of medical, dental, vision, and short-term disability claims that HMA administers for our members.
Your role goes beyond handling claims, you'll be a key player in shaping a positive healthcare experience for our members. Every claim you interact with helps someone navigate their healthcare journey with confidence, making your work both meaningful and impactful.
What YOU will do:
Research and process ITS claim adjustments, returned checks, refunds and stop payment in an accurate and timely manner
Communicate with local Blue plans utilizing real time chat
Process priority claims and general inquiries
Respond to appeals and correspondence regarding claims functions
Support team members and be open to providing assistance when and where neede Become a SME regarding BCBS network
Requirements
High school diploma required
3-5+ years of claims processing experience
2+ years of BCBS claims processing experience required
Strong interpersonal and communication skills
Strong attention to detail, with high degree of accuracy and urgency
Ability to take initiative and ownership of assigned tasks, working independently with minimal supervision, yet maintain a team-oriented and collaborative approach to problem solving
Previous success in a fast-paced environment
Benefits
Compensation:
The base salary range for this position in the greater Seattle area is $28/hr - $32/hr for a level II and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level II, we may consider level III for highly qualified candidates.
Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.
In addition, HMA provides a generous total rewards package for full-time employees that includes:
Seventeen (IC) days paid time off (individual contributors)
Eleven paid holidays
Two paid personal and one paid volunteer day
Company-subsidized medical, dental, vision, and prescription insurance
Company-paid disability, life, and AD&D insurances
Voluntary insurances
HSA and FSA pre-tax programs
401(k)-retirement plan with company match
Annual $500 wellness incentive and a $600 wellness reimbursement
Remote work and continuing education reimbursements
Discount program
Parental leave
Up to $1,000 annual charitable giving match
How we Support your Work, Life, and Wellness Goals
At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party.
We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.)
HMA requires a background screen prior to employment.
Protected Health Information (PHI) Access
Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures.
HMA is an Equal Opportunity Employer.
For more information about HMA, visit: *****************
$28 hourly Auto-Apply 30d ago
Claims Specialist II
Healthcare Management Administrators 4.0
Bellevue, WA jobs
HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.
We are proud to say that for three years, HMA has been chosen as a ‘Washington's Best Workplaces' by our Staff and PSBJ™. Our vision, ‘Proving What's Possible in Healthcare™,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.
What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven.
What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: *****************
How YOU will make a Difference:
As a Claims Specialist, you'll be at the heart of our mission to deliver exceptional service. Working alongside a dedicated team, you'll ensure the accurate and timely processing of medical, dental, vision, and short-term disability claims that HMA administers for our members.
Your role goes beyond handling claims, you'll be a key player in shaping a positive healthcare experience for our members. Every claim you interact with helps someone navigate their healthcare journey with confidence, making your work both meaningful and impactful.
What YOU will do:
Carefully research discrepancies, process returned checks, issue refunds, and manage stop payments with precision. This ensures financial accuracy and builds trust with both clients and members.
Manage high-importance claims and vendor billing with urgency and attention to detail.
Review and reply to appeals, inquiries, and other communications related to claims.
Work with third-party organizations to secure payments on outstanding balances.
Process case management and utilization review negotiated claims
Spot potential subrogation claims and escalate them appropriately.
Actively contribute to team success by assisting colleagues when workloads peak, sharing knowledge, and fostering a collaborative environment.
Requirements
High school diploma required
3-5+ years of claims processing experience
2+ years of BCBS claims processing experience
Strong interpersonal and communication skills
Strong attention to detail, with high degree of accuracy and urgency
Ability to take initiative and ownership of assigned tasks, working independently with minimal supervision, yet maintain a team-oriented and collaborative approach to problem solving
Previous success in a fast-paced environment
Benefits
Compensation:
The base salary range for this position in the greater Seattle area is $28/hr - $32/hr for a level II and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level II, we may consider level III for highly qualified candidates.
Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.
In addition, HMA provides a generous total rewards package for full-time employees that includes:
Seventeen (IC) days paid time off (individual contributors)
Eleven paid holidays
Two paid personal and one paid volunteer day
Company-subsidized medical, dental, vision, and prescription insurance
Company-paid disability, life, and AD&D insurances
Voluntary insurances
HSA and FSA pre-tax programs
401(k)-retirement plan with company match
Annual $500 wellness incentive and a $600 wellness reimbursement
Remote work and continuing education reimbursements
Discount program
Parental leave
Up to $1,000 annual charitable giving match
How we Support your Work, Life, and Wellness Goals
At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party.
We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.)
HMA requires a background screen prior to employment.
Protected Health Information (PHI) Access
Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures.
HMA is an Equal Opportunity Employer.
For more information about HMA, visit: *****************
$28 hourly Auto-Apply 37d ago
Senior Claims Adjudicator
Naphcare 4.7
Birmingham, AL jobs
NaphCare is hiring an experienced Senior Claims Adjudicator just like you to join our team at our Corporate Office in Birmingham, AL.
NaphCare is a family owned, medical technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 30 years. Come join our team of over 6000 employees and growing! NaphCare pays well, offers outstanding benefits, and has an incredibly engaged corporate support team to make sure you have what you need to be truly excellent at what you do.
NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. We recognize that we serve a unique and diverse patient population, and our onsite teams take pride in bringing excellence in care to a population in great need. Be part of a world-class team of professionals who are revolutionizing correctional healthcare as you use our cutting-edge resources, including our award-winning electronic operating system.
NaphCare Benefits for Full-Time Employees Include:
Prescriptions free of charge through our health plan
Health, dental & vision insurance that starts day one!
Employment Assistance Program (EAP) services
401K and Roth with company contribution that starts day one!
Tuition Assistance
Referral bonuses
On-site education
Free Continuing Education!
Term life insurance at no cost to the employee
Generous paid time off & paid holidays
NaphCare has a partnership with NetCE that provides CEU/CME for our staff. NetCE uses a rigorous peer review process to ensure that all activities and content are up to date. This service streamlines continuing education for all NaphCare Employees to meet state specific requirements for maintaining licensing.
With NaphCare, you'll play a critical role in our continuing mission to be the leading provider of quality healthcare in the correctional industry. If you want a career that will make a difference, choose the company that is different.
We support your growth and internal promotion. Once hired, we encourage our employees to continue to seek opportunities for advancement and leadership.
Responsibilities
Responsibilities for Senior Claim Adjudicator:
Utilize claims processing experience and working knowledge of Medicare and Medicaid to effectively and efficiently process claims for payment while adhering to internal deadlines.
Demonstrate ability to handle daily workload with speed and accuracy.
Demonstrate a high comfort level in working with large volumes of data.
Demonstrate the ability to act as a mentor for others within team.
Demonstrate a strong attention to detail and a commitment to customer service throughout the claims process.
Additional duties and specific projects as assigned.
Qualifications
Qualifications for Senior Claim Adjudicator:
Associate Degree or higher or equivalent work experience.
Minimum five years of recent adjudication experience required.
An ability to define and calculate Medicare and Medicaid is critical.
Working knowledge of medical terminology, billing standards, and Medicare and Medicaid methodologies.
Proficiency in Microsoft Office Suite and strong written and verbal communication skills are also required.
CPC, COC, CIC, or Specialty Medical Coding Certification preferred.
If you would like to speak with our Talent Acquisition team to learn more about this position and NaphCare, please first apply directly to this position to initiate the application process, and then please send your resume to ************************* where we will be in touch.
Equal Opportunity Employer: disability/veteran
$33k-49k yearly est. Auto-Apply 10d ago
Claims Specialist - USFHP
Pacific Medical Centers 4.6
Renton, WA jobs
Adjudicates claims submitted by outside purchased services for PMC's enrolled capitated population and communicates those actions. Adjusts complex claims for advanced processing needs. Responds to Customer Service Requests and resolves problem claim situations.
Providence caregivers are not simply valued - they're invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
+ H.S. Diploma or GED or equivalent experience in Health Care Business Administration.
+ 2 years in Managed Care operations.
+ 1 year of Claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.
+ Experience with areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health and Encounters).
+ Information systems supporting the administration of managed care products.
Preferred Qualifications:
+ IDX healthcare software application.
+ CHAMPUS, Medicare and/or Medicaid benefits/programs.
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.
About Providence
At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
About the Team
Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting-edge technology, first-class facilities and board-certified providers.
Our strong team environment and respect for our people-at all levels and from all backgrounds-allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
For any concerns with this posting relating to the posting requirements in RCW 49.58.110(1), please click here where you can access an email link to submit your concern.
Requsition ID: 404135
Company: Pacific Medical Jobs
Job Category: Claims
Job Function: Revenue Cycle
Job Schedule: Full time
Job Shift: Day
Career Track: Admin Support
Department: 3060 WA USFHP
Address: WA Seattle 1200 12th Ave S
Work Location: PACMED Admin Bh-Seattle
Workplace Type: On-site
Pay Range: $21.01 - $32.57
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
EAMC MISSION
At East Alabama Medical Center, our mission is high quality, compassionate health care, and that statement guides everything we do. We set high standards for customer service, quality, and keeping costs under control.
POSITION SUMMARY
The ClaimsAnalyst for Credits is responsible for accurately and compliantly filing credit balance reports. This includes working various reports and queues, working insurance credit balances and self-pay credit balances, working correspondence from insurance carriers, staff members and other departments.
POSITION QUALIFICATIONS
Minimum Education
High School Diploma or equivalent required
Minimum Experience
1 year of experience
Required Registration/License/Certification
N/A
Preferred Education
Associates Degree or Higher
Preferred Experience
2 or more years of Healthcare Related Experience
Preferred Registration/License/Certification
N/A
Other Requirements
N/A
$24k-51k yearly est. 46d ago
Coding Charge Analyst
Infirmary Health System 4.4
Mobile, AL jobs
Qualifications Minimum Qualifications: * Knowledge of medical terminology and coding conventions (ICD10-CM/PCS, CPT, and HCPCS) * Computer proficiency, ability to research coding questions and utilize educational resources required
* Independent, focused individual with ability to work remotely
Desired Qualifications:
Associate degree
Coding experience
Infusion and Injection Charging experience
Licensure, Registration, Certification:
Credentialed as one of the following:
* Certified Outpatient Coder (COC, COC-A)
* Certified Inpatient Coder (CIC)
* Certified Professional Coder (CPC, CPC-A)
* Registered Health Info Technician (RHIT)
* Registered Health Info Administrator (RHIA)
* Certified Coding Specialist (CCS)
* Certified Coding Associate (CCA)
Responsibilities
Assigns Emergency Department CPT codes through the charge process according to established regulatory guidelines, industry best practices, and IH policies and procedures. *This position requires you to be onsite. Applicants must live within driving distance of Mobile, AL*
$64k-82k yearly est. Auto-Apply 35d ago
Claims Specialist - USFHP
Pacific Medical Centers 4.6
Seattle, WA jobs
Adjudicates claims submitted by outside purchased services for PMC's enrolled capitated population and communicates those actions. Adjusts complex claims for advanced processing needs. Responds to Customer Service Requests and resolves problem claim situations.
Providence caregivers are not simply valued - they're invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
+ H.S. Diploma or GED or equivalent experience in Health Care Business Administration.
+ 2 years in Managed Care operations.
+ 1 year of Claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.
+ Experience with areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health and Encounters).
+ Information systems supporting the administration of managed care products.
Preferred Qualifications:
+ IDX healthcare software application.
+ CHAMPUS, Medicare and/or Medicaid benefits/programs.
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.
About Providence
At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
About the Team
Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting-edge technology, first-class facilities and board-certified providers.
Our strong team environment and respect for our people-at all levels and from all backgrounds-allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
For any concerns with this posting relating to the posting requirements in RCW 49.58.110(1), please click here where you can access an email link to submit your concern.
Requsition ID: 404135
Company: Pacific Medical Jobs
Job Category: Claims
Job Function: Revenue Cycle
Job Schedule: Full time
Job Shift: Day
Career Track: Admin Support
Department: 3060 WA USFHP
Address: WA Seattle 1200 12th Ave S
Work Location: PACMED Admin Bh-Seattle
Workplace Type: On-site
Pay Range: $21.01 - $32.57
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
$21-32.6 hourly 9d ago
Claims Specialist - USFHP
Providence Health & Services 4.2
Seattle, WA jobs
Adjudicates claims submitted by outside purchased services for PMC's enrolled capitated population and communicates those actions. Adjusts complex claims for advanced processing needs. Responds to Customer Service Requests and resolves problem claim situations.
Providence caregivers are not simply valued - they're invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
+ H.S. Diploma or GED or equivalent experience in Health Care Business Administration.
+ 2 years in Managed Care operations.
+ 1 year of Claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.
+ Experience with areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health and Encounters).
+ Information systems supporting the administration of managed care products.
Preferred Qualifications:
+ IDX healthcare software application.
+ CHAMPUS, Medicare and/or Medicaid benefits/programs.
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.
About Providence
At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
About the Team
Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting-edge technology, first-class facilities and board-certified providers.
Our strong team environment and respect for our people-at all levels and from all backgrounds-allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
For any concerns with this posting relating to the posting requirements in RCW 49.58.110(1), please click here where you can access an email link to submit your concern.
Requsition ID: 404135
Company: Pacific Medical Jobs
Job Category: Claims
Job Function: Revenue Cycle
Job Schedule: Full time
Job Shift: Day
Career Track: Admin Support
Department: 3060 WA USFHP
Address: WA Seattle 1200 12th Ave S
Work Location: PACMED Admin Bh-Seattle
Workplace Type: On-site
Pay Range: $21.01 - $32.57
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
$21-32.6 hourly Auto-Apply 25d ago
Inpatient Coding Analyst IV - $6K Sign On
Southeast Health 4.4
Alabama jobs
Southeast. Always the right career direction. Summary$6K Sign On Bonus Job DescriptionQUALIFICATIONS:
Must be a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS).;
Minimum of five years' experience in hospital coding, including Medicare inpatients with demonstrated knowledge of diagnosis-related group (DRG) regulations, as evidenced by a score of at least 90% on a coding test or six months of DRG coding with proven accuracy.
LANGUAGE/ COMMUNICATION SKILLS:
Excellent oral and written communication skills.
SKILLS:
Knowledge of personal computers.
ShiftDayShift DetailsFirst
FTE1
TypeRegular
Join one of Forbes 500 best mid-sized employers in America.
Equal Employment Employer
Southeast Health is committed to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Southeast Health will provide reasonable accommodations for qualified individuals with disabilities.