Claim Specialist jobs at Providence Health & Services - 1007 jobs
Claims Specialist - USFHP
Providence Health & Services 4.2
Claim specialist job at Providence Health & Services
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 36d ago
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Specialist, Provider Engagement (must reside in South Carolina - upstate or low country)
Molina Healthcare 4.4
Charleston, SC jobs
The Provider Engagement Specialist, role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the smaller, less advanced Tier 2 and Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for the Provider Engagement team. Communicates effectively with healthcare professionals and maintains compliance with policies.
Job Duties
• Ensures assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals.
• Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.
• Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.
• Drives provider participation in Molina risk adjustment and quality efforts (e.g. Supplemental data, EMR connection, Clinical Profiles programs) and use of the Molina Provider Collaboration Portal.
• Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness both within and across Molina Health Plans.
• Serves as a Provider Engagement subject matter expert; works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals.
• Accountable for use of standard Molina Provider Engagement reports and training materials.
• Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.
• Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies.
• Communicates comfortably and effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices.
• Maintains the highest level of compliance.
• This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location.
JOB QUALIFICATIONS
REQUIRED QUALIFICATIONS:
• Associate's degree or equivalent combination of education and work experience.
• 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience.
• Working knowledge of Quality metrics and risk adjustment practices across all business lines
• Demonstrates data analytic skills
• Operational knowledge and experience with PowerPoint, Excel, Visio
• Effective communication skills
• Strong leadership skills"
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCore
#LI-AC1
#HTF
Pay Range: $43,121 - $88,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$24k-28k yearly est. 2d ago
Specialist, Provider Engagement (must reside in South Carolina - upstate or low country)
Molina Healthcare 4.4
Spartanburg, SC jobs
The Provider Engagement Specialist, role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the smaller, less advanced Tier 2 and Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for the Provider Engagement team. Communicates effectively with healthcare professionals and maintains compliance with policies.
Job Duties
• Ensures assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals.
• Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.
• Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.
• Drives provider participation in Molina risk adjustment and quality efforts (e.g. Supplemental data, EMR connection, Clinical Profiles programs) and use of the Molina Provider Collaboration Portal.
• Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness both within and across Molina Health Plans.
• Serves as a Provider Engagement subject matter expert; works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals.
• Accountable for use of standard Molina Provider Engagement reports and training materials.
• Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.
• Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies.
• Communicates comfortably and effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices.
• Maintains the highest level of compliance.
• This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location.
JOB QUALIFICATIONS
REQUIRED QUALIFICATIONS:
• Associate's degree or equivalent combination of education and work experience.
• 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience.
• Working knowledge of Quality metrics and risk adjustment practices across all business lines
• Demonstrates data analytic skills
• Operational knowledge and experience with PowerPoint, Excel, Visio
• Effective communication skills
• Strong leadership skills"
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCore
#LI-AC1
#HTF
Pay Range: $43,121 - $88,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$24k-28k yearly est. 2d ago
Specialist, Provider Engagement (must reside in South Carolina - upstate or low country)
Molina Healthcare 4.4
Florence, SC jobs
The Provider Engagement Specialist, role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the smaller, less advanced Tier 2 and Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for the Provider Engagement team. Communicates effectively with healthcare professionals and maintains compliance with policies.
Job Duties
• Ensures assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals.
• Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.
• Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.
• Drives provider participation in Molina risk adjustment and quality efforts (e.g. Supplemental data, EMR connection, Clinical Profiles programs) and use of the Molina Provider Collaboration Portal.
• Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness both within and across Molina Health Plans.
• Serves as a Provider Engagement subject matter expert; works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals.
• Accountable for use of standard Molina Provider Engagement reports and training materials.
• Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.
• Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies.
• Communicates comfortably and effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices.
• Maintains the highest level of compliance.
• This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location.
JOB QUALIFICATIONS
REQUIRED QUALIFICATIONS:
• Associate's degree or equivalent combination of education and work experience.
• 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience.
• Working knowledge of Quality metrics and risk adjustment practices across all business lines
• Demonstrates data analytic skills
• Operational knowledge and experience with PowerPoint, Excel, Visio
• Effective communication skills
• Strong leadership skills"
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCore
#LI-AC1
#HTF
Pay Range: $43,121 - $88,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$24k-28k yearly est. 2d ago
Specialist, Provider Engagement (must reside in South Carolina - upstate or low country)
Molina Healthcare 4.4
Columbia, SC jobs
The Provider Engagement Specialist, role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the smaller, less advanced Tier 2 and Tier 3 providers have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for the Provider Engagement team. Communicates effectively with healthcare professionals and maintains compliance with policies.
Job Duties
• Ensures assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals.
• Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.
• Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.
• Drives provider participation in Molina risk adjustment and quality efforts (e.g. Supplemental data, EMR connection, Clinical Profiles programs) and use of the Molina Provider Collaboration Portal.
• Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness both within and across Molina Health Plans.
• Serves as a Provider Engagement subject matter expert; works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals.
• Accountable for use of standard Molina Provider Engagement reports and training materials.
• Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.
• Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies.
• Communicates comfortably and effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices.
• Maintains the highest level of compliance.
• This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location.
JOB QUALIFICATIONS
REQUIRED QUALIFICATIONS:
• Associate's degree or equivalent combination of education and work experience.
• 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience.
• Working knowledge of Quality metrics and risk adjustment practices across all business lines
• Demonstrates data analytic skills
• Operational knowledge and experience with PowerPoint, Excel, Visio
• Effective communication skills
• Strong leadership skills"
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCore
#LI-AC1
#HTF
Pay Range: $43,121 - $88,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$24k-28k yearly est. 2d ago
MR Fusion Specialist
United Medical Systems 4.1
Columbus, OH jobs
Schedule: Full-time | Guaranteed 80 hours per pay period/flexible and changing schedule
Radiologic Technologist/ MRI/CT Tech or Ultrasound Tech for MR Fusion Biopsy Specialist
United Medical Systems, a national leader in mobile medical services, is currently seeking medical imaging professionals with MRI, Ultrasound, or Radiologic Technology/Interventional experience for a Full-Time position. Our highly specialized Fusion Biopsy Technologists travel to various hospitals in their assigned region each month to provide the MR Fusion device and support the Urologists in its operation for MR Fusion Prostate Biopsy procedures in the OR.
MR Fusion Biopsy is a revolutionary new procedure which is changing the landscape for detecting Prostate cancer earlier and more accurately. Our MR Fusion Specialists work independently and oversee the logistical and clinical needs for their route in preparation for the procedures.
Responsibilities include of MR / Radiology / Ultrasound / Fusion Specialist:
Communicating with Urology offices to confirm upcoming schedule
Obtaining MRI Mappings from the Radiology teams (can be accomplished remotely through the Cloud)
Traveling to facilities to deliver the equipment prior to day of procedures
Providing technical and clinical support to the Urologists during the procedures.
This position does not involve performing MRI scans but does involve assisting the Urologist in fusing the MRI Mapping to the live Ultrasound capture and in navigating in a 3D environment with the Fusion device.
This is a unique opportunity to become part of a new movement in Prostate cancer detection, and to help in the ongoing development of this new program at UMS. Our company's mission is to deliver this potentially life-saving technology to suburban and community hospitals nationwide.
Extensive training will be provided for operating the fusion device and ultrasound. If you enjoy new technology, furthering your specialization as an imaging professional, and working independently, this could be an ideal fit for you. Some overnight travel may be required for certain facilities.
Perks & Pay
Guaranteed 80 hours per pay period/two week pay periods
Paid training in advanced mobile lithotripsy systems
Travel expenses and hotel stays reimbursed
Full benefits package
Be part of a passionate, mission-driven team
Benefits:
Medical insurance
Dental Insurance
Vision Insurance
Fully Paid STD/LTD Insurance
Fully Paid 2x Basic life Insurance
401k with excellent company match
Paid Vacation/sick/personal Time
pm19
PI62451d***********8-39557054
$26k-47k yearly est. 2d ago
Healthy Lifestyle Specialist
Boys & Girls Club of Austin 3.8
Austin, TX jobs
(Essential Job Responsibilities): Creates, implements, promotes, and manages Healthy Lifestyles and Sports programs and activities that promote healthy living and physical activity. Coordinates fee-based programs. Trains and ensures all staff are com Health, Specialist, Sports, Staff, Monitoring, Healthcare
$31k-42k yearly est. 3d ago
Director, Provider Enrollment
Baylor Scott & White Health 4.5
Dallas, TX jobs
The Director, Provider Enrollment, is responsible for the strategic planning, evaluation, and operational management of the Provider Enrollment department for Baylor Scott and White Health (BSWH). This role will be responsible for overseeing the enrollment of BSWH facilities and providers with government and managed care payers, ensuring all processes comply with regulatory and payer requirements. The Director, Provider Enrollment guides the management team and staff to ensure facility enrollment applications are submitted promptly and payer provider numbers are obtained timely, supporting accurate and efficient payer enrollments and claims submission. Collaborates with Legal, Compliance, Managed Care, Medical Staff Services, Government Finance, Revenue Cycle and other BSWH departments to secure and maintain payer enrollments.
Essential Functions of the Role
Directs the day-to-day operations of third-party payer enrollment functions and is directly responsible for ensuring payer enrollments and revalidations are completed timely and accurately
Recommends and implements strategic and operational plans and priorities for provider and facility payer enrollments aligned to BSWH overall business objectives
Leads and manages department functions, including management of personnel to achieve effective and efficient operations
Establishes and maintains necessary department specific policies and procedures that support and advance department and organizational objectives
Develops key operational reports and metrics, monitors department performance indicators, and identifies opportunities for improving processes
Ensures CMS attestations and applications are filed timely for hospital-based department designations
Oversees the build and maintenance of current, complete, and accurate provider profiles and rosters
Establishes horizontal and vertical relationships with colleagues, vendors, and payers to achieve standardization in provider enrollment processes and ensure organizational enrollment expectations are being met
Collaborates with Centralized Business Services (CBS) billing and insurance collections leadership for resolution of patient accounting system enrollment edits and/or denials to ensure timely reimbursement
Develops subject matter expertise to serve as resource to Revenue Cycle leadership, colleagues, and team members and proactively stays abreast of industry regulations that impact provider enrollment functions
Performs other position appropriate duties as required in a competent, professional and courteous manner
Key Success Factors
Bachelor's degree in healthcare administration or related field. Master's degree preferred.
10+ years of experience in a large integrated healthcare system
5+ years of experience in provider enrollment and/or revenue cycle preferred
3+ years of experience in a leadership role
Strong understanding of governmental and commercial payer requirements, applications and workflows
Familiarity with PECOS and State Medicaid Provider Enrollment and Management Systems preferred
Experience collaborating across multiple departments and stakeholders within a large, complex healthcare organization preferred
Excellent communication skills and ability to create executive-level presentations and deliverables
Ability to manage multiple priorities, meet key deadlines, and drive performance improvement initiatives
Strong problem-solving, organizational, and critical thinking skills
Ability to handle confidential information with discretion
Qualifications
EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
EXPERIENCE - 3 Years of Experience
$31k-49k yearly est. 2d ago
CLAIMS SPECIALIST
Community Health Services 3.5
Fremont, OH jobs
Come to work with us at Community Health Services! We offer full-time benefits, 10 paid holidays, no weekend hours and so much more! We are looking for a full-time ClaimsSpecialist to work in our Fremont office. CHS employs those who are eager to grow professionally, gain great experience, and work with a terrific team. The ClaimsSpecialist will be responsible for performing general finance functions, entering encounters, processing and recording claims and all other duties as assigned.
Hours for this position are:
Mondays 7am-7pm, Tuesdays through Thursdays 8am-5pm, Fridays 8am-1pm
Qualified candidates must have the following to be considered for employment:
* Associate's degree from an accredited college or university
* Experience in accounting/bookkeeping
* Demonstrates ability to organize and implement general accounting and bookkeeping procedures for a healthcare organization
* Ability to work with clinic personnel and patients in a courteous, cooperative manner
* Ability to function as part of a team
* Must have excellent customer service skills
* Must have excellent multi-tasking, problem solving, and decision-making skills
* Ability to follow instructions with attention to detail
* Demonstrates professional relationship skills, and a strong work ethic
* Prioritizes responsibilities, takes initiative, and possesses excellent organizational skills
* Demonstrates effective communication skills
* Ability to work with a culturally diverse group of people
At CHS, we value our team and the critical role they play in patient care. If you're dependable, detail-oriented, and passionate about making a difference in your community, we'd love to hear from you. CHS is a drug-free/nicotine free organization. Candidates must pass a drug and nicotine screening upon employment offer.
$40k-52k yearly est. 43d ago
Claims Specialist- Journal Center, (784)
Tricore Reference Laboratories 4.6
Albuquerque, NM jobs
Schedule: Monday-Friday 8:00 AM-5:00PM and other shifts as needed.
Responsible for collecting accounts receivables on patient accounts, non-government and contracted insurances government payers and secondary billing. Responsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports.
ESSENTIAL FUNCTIONS:
1. Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration.
2. Pursues collection activities on assigned accounts from primary and secondary payors until worked to resolution to include claims resubmission, appeal or reconsideration.
3. Works account receivables reports (i.e. aged-trial-balance report), focusing attention on accounts over 60 days.
4. Researches adjustments and pull all necessary backup to support adjustments.
5. Utilizes on-line insurance resources to obtain and maintain current information.
6. Develops and maintains a professional working rapport with internal and external customers to include contacts with insurance company representatives.
7. Identifies trends in payment or non-payment of claims. Communicates findings to leadership and co-workers as appropriate.
8. Customizes reports in Antrim and or Excel to prioritize accounts for collecting.
The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.
MINIMUM EDUCATION:
High school diploma or equivalent
MINIMUM EXPERIENCE:
Must have one of the following:
Six (6) months as an Apprentice in the Business Office at TriCore
Minimum of one (1) year of laboratory or medical claims follow-up/collections experience
Minimum of three (3) years of medical billing or claims processing experience
OTHER REQUIREMENTS:
Must be able to type 30 words per minute (typing test required)
Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications
PREFERENCES: Basic knowledge of Excel and Word Knowledge of medical terminology
IMMUNIZATION REQUIREMENTS: Prove immunity to Hepatitis B or be immunized or sign a waiver refusing hepatitis immunization. Provide documentation of a PPD test conducted not more than 90 days prior to date of hire or have a PPD test conducted.
GENERAL REQUIREMENTS:
1. Proficient in PC/data entry skills
2. Must be able to work independently with little direction and to demonstrate sound judgment and problem solving skills
3. Ability to resolve problems and follow up as needed or appropriate
4. Effective communication skills and telephone skills
5. Ability to deal with difficult clients and patients
6. Strong working knowledge of insurance and reimbursement
$38k-62k yearly est. 60d+ ago
Claims Specialist-Journal Center, (783)
Tricore Reference Laboratories 4.6
Albuquerque, NM jobs
Schedule: Monday-Friday 0800 - 1230 w/ 30 min lunch and other shifts as needed.
Responsible for collecting accounts receivables on patient accounts, non-government and contracted insurances government payers and secondary billing. Responsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports.
ESSENTIAL FUNCTIONS:
1. Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration.
2. Pursues collection activities on assigned accounts from primary and secondary payors until worked to resolution to include claims resubmission, appeal or reconsideration.
3. Works account receivables reports (i.e. aged-trial-balance report), focusing attention on accounts over 60 days.
4. Researches adjustments and pull all necessary backup to support adjustments.
5. Utilizes on-line insurance resources to obtain and maintain current information.
6. Develops and maintains a professional working rapport with internal and external customers to include contacts with insurance company representatives.
7. Identifies trends in payment or non-payment of claims. Communicates findings to leadership and co-workers as appropriate.
8. Customizes reports in Antrim and or Excel to prioritize accounts for collecting.
The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.
MINIMUM EDUCATION:
High school diploma or equivalent
MINIMUM EXPERIENCE:
Must have one of the following:
Six (6) months as an Apprentice in the Business Office at TriCore
Minimum of one (1) year of laboratory or medical claims follow-up/collections experience
Minimum of three (3) years of medical billing or claims processing experience
OTHER REQUIREMENTS:
Must be able to type 30 words per minute (typing test required)
Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications
PREFERENCES: Basic knowledge of Excel and Word Knowledge of medical terminology
IMMUNIZATION REQUIREMENTS: Prove immunity to Hepatitis B or be immunized or sign a waiver refusing hepatitis immunization. Provide documentation of a PPD test conducted not more than 90 days prior to date of hire or have a PPD test conducted.
GENERAL REQUIREMENTS:
1. Proficient in PC/data entry skills
2. Must be able to work independently with little direction and to demonstrate sound judgment and problem solving skills
3. Ability to resolve problems and follow up as needed or appropriate
4. Effective communication skills and telephone skills
5. Ability to deal with difficult clients and patients
6. Strong working knowledge of insurance and reimbursement
$38k-62k yearly est. 60d+ ago
Pharmacy Claims Specialist
Infirmary Health 4.4
Daphne, AL jobs
Overview Qualifications
Minimum Qualifications:
Strong verbal and written communication skills
Desired Qualifications:
Working knowledge of pharmacy claims, adjudication, and insurance billing processes
Licensure. Registration, Certification:
Current registry with the Alabama Board of Pharmacy
Responsibilities
Ensures accurate and efficient processing of prescription claims while supporting pharmacies and patients to provide high quality patient care which meets Infirmary Health's (IH) standards of quality, efficiency, and desired outcomes.
$63k-80k yearly est. Auto-Apply 3d ago
Claims Specialist - Covered California
IEHP 4.7
California, MD jobs
What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Under the direction of the Covered California Claims (CCA) Manager, the CCA ClaimsSpecialist is responsible for analyzing, managing, and investigating complex and high-dollar healthcare claims that require in-depth research to determine accuracy and mitigate payment errors. The ClaimsSpecialist is also responsible for adjusting first-pass and post-pay claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. This position collaborates with internal stakeholders, assists with claim audits (internal and regulatory) and utilizes strong analytical skills and independent judgement skills to make effective and accurate decisions. This position will also be responsible for responding to inquiries from the Provider Payment Resolution team on claims that may have been paid incorrectly.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
* Competitive salary
* Telecommute schedule
* State of the art fitness center on-site
* Medical Insurance with Dental and Vision
* Life, short-term, and long-term disability options
* Career advancement opportunities and professional development
* Wellness programs that promote a healthy work-life balance
* Flexible Spending Account - Health Care/Childcare
* CalPERS retirement
* 457(b) option with a contribution match
* Paid life insurance for employees
* Pet care insurance
Education & Requirements
* Three (3) years of experience in examining and processing complex and high-dollar institutional and professional claims
* Experience in a managed care environment helpful. Commercial, Exchange, and Medicare preferred
* High school diploma or GED required
* Associate's degree from an accredited institution preferred
Key Qualifications
* ICD-9/ ICD-10 and CPT coding and general practices of claims processing
* CMS/DMHC and Affordable Care Act regulations and guidelines
* Commercial line of business specifically Covered California/Exchange
* Excellent communication and interpersonal skills
* Excellent analytical, critical thinking, customer service, and organizational skills
* Ability to think critically with the capacity to work independently
* All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership
Start your journey towards a thriving future with IEHP and apply TODAY!
Pay Range
* $25.90 USD Hourly - $33.02 USD Hourly
$25.9-33 hourly 22d ago
Claims Specialist - Covered California
IEHP 4.7
California jobs
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!
Under the direction of the Covered California Claims (CCA) Manager, the CCA ClaimsSpecialist is responsible for analyzing, managing, and investigating complex and high-dollar healthcare claims that require in-depth research to determine accuracy and mitigate payment errors. The ClaimsSpecialist is also responsible for adjusting first-pass and post-pay claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. This position collaborates with internal stakeholders, assists with claim audits (internal and regulatory) and utilizes strong analytical skills and independent judgement skills to make effective and accurate decisions. This position will also be responsible for responding to inquiries from the Provider Payment Resolution team on claims that may have been paid incorrectly.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Additional Benefits
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
Competitive salary
Telecommute schedule
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account - Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance
Key Responsibilities
Work effectively with other departments (i.e., Special Investigation Unit, Provider Payment Resolution team, and other departments/stakeholders) to investigate and identify fraud, respond to escalated provider inquiries timely, and support the claims process.
Investigate and process complex and high-dollar claims determining accuracy and making timely decisions.
Advise leadership and internal business units (as applicable) of findings and outcomes on identified claim issues.
Research and analyze medical claims adjustment requests along with related documentation to determine payment accuracy and adjust/adjudicate as needed in the Health Rules Processing system and other platforms.
Research claims that may have been paid incorrectly and communicate findings for adjustment. Adjust claims based on findings (i.e., correct coding, rates of reimbursement, authorizations, contracted amounts, etc.) ensuring that all relevant information is considered.
Assist with internal and regulatory claim audits, reviewing claim accuracy.
Identify trends and recommend improvements to IEHP's claim processing system.
Analyze and investigate insurance claims to discover or prevent fraud.
Be an active participant in the Claims Department's initiatives and participate in Claims Huddles, etc.
Remain current with all claim processing changes/updates (i.e. internal processes, regulatory guidelines).
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.
Qualifications
Education & Requirements
Three (3) years of experience in examining and processing complex and high-dollar institutional and professional claims
Experience in a managed care environment helpful. Commercial, Exchange, and Medicare preferred
High school diploma or GED required
Associate's degree from an accredited institution preferred
Key Qualifications
ICD-9/ ICD-10 and CPT coding and general practices of claims processing
CMS/DMHC and Affordable Care Act regulations and guidelines
Commercial line of business specifically Covered California/Exchange
Excellent communication and interpersonal skills
Excellent analytical, critical thinking, customer service, and organizational skills
Ability to think critically with the capacity to work independently
All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership
Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location
Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)
Pay Range USD $25.90 - USD $33.02 /Hr.
$25.9-33 hourly Auto-Apply 15d ago
Claims Specialist - Covered California
Inland Empire Health Plan 4.7
California jobs
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!
Under the direction of the Covered California Claims (CCA) Manager, the CCA ClaimsSpecialist is responsible for analyzing, managing, and investigating complex and high-dollar healthcare claims that require in-depth research to determine accuracy and mitigate payment errors. The ClaimsSpecialist is also responsible for adjusting first-pass and post-pay claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. This position collaborates with internal stakeholders, assists with claim audits (internal and regulatory) and utilizes strong analytical skills and independent judgement skills to make effective and accurate decisions. This position will also be responsible for responding to inquiries from the Provider Payment Resolution team on claims that may have been paid incorrectly.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Additional Benefits
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
Competitive salary
Telecommute schedule
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account - Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance
Key Responsibilities
Work effectively with other departments (i.e., Special Investigation Unit, Provider Payment Resolution team, and other departments/stakeholders) to investigate and identify fraud, respond to escalated provider inquiries timely, and support the claims process.
Investigate and process complex and high-dollar claims determining accuracy and making timely decisions.
Advise leadership and internal business units (as applicable) of findings and outcomes on identified claim issues.
Research and analyze medical claims adjustment requests along with related documentation to determine payment accuracy and adjust/adjudicate as needed in the Health Rules Processing system and other platforms.
Research claims that may have been paid incorrectly and communicate findings for adjustment. Adjust claims based on findings (i.e., correct coding, rates of reimbursement, authorizations, contracted amounts, etc.) ensuring that all relevant information is considered.
Assist with internal and regulatory claim audits, reviewing claim accuracy.
Identify trends and recommend improvements to IEHP's claim processing system.
Analyze and investigate insurance claims to discover or prevent fraud.
Be an active participant in the Claims Department's initiatives and participate in Claims Huddles, etc.
Remain current with all claim processing changes/updates (i.e. internal processes, regulatory guidelines).
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.
Qualifications
Education & Requirements
Three (3) years of experience in examining and processing complex and high-dollar institutional and professional claims
Experience in a managed care environment helpful. Commercial, Exchange, and Medicare preferred
High school diploma or GED required
Associate's degree from an accredited institution preferred
Key Qualifications
ICD-9/ ICD-10 and CPT coding and general practices of claims processing
CMS/DMHC and Affordable Care Act regulations and guidelines
Commercial line of business specifically Covered California/Exchange
Excellent communication and interpersonal skills
Excellent analytical, critical thinking, customer service, and organizational skills
Ability to think critically with the capacity to work independently
All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership
Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location
Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)
Pay Range USD $25.90 - USD $33.02 /Hr.
$25.9-33 hourly Auto-Apply 60d+ ago
Claims Specialist
Mountain Valley Express 2.9
Norco, CA jobs
Full-time Description ClaimsSpecialist - Job Description
Jurupa Valley, CA - Onsite
Who We Are
Mountain Valley Express (MVE) is a leading LTL Carrier and 3PL Services provider with locations across California, Arizona, and Nevada.
With years of experience, a dedicated team, and cutting-edge technology, MVE offers a broad range of services, including less-than-truckload (LTL), full truckload, custom invoicing and auditing, optimization, warehousing and distribution, engineering solutions, and packaging and shipping supplies. Our deep understanding of the market, along with strong carrier partnerships, allows us to deliver highly tailored services that meet the unique needs of our customers.
Benefits
· Comprehensive medical, dental, and vision insurance.
· 401(k) plan with company match.
· Company-paid Life and AD&D Insurance policies.
· Paid vacation, sick leave, and holidays.
The Opportunity
We are seeking a ClaimsSpecialist to join our team. In this role, you will be responsible for managing the end-to-end freight claims process, including receipt, investigation, documentation, and resolution. This position is integral to maintaining MVE's reputation for accuracy, transparency, and customer service excellence. You will work closely with the Operations, Customer Service, and Accounting teams to ensure claims are resolved efficiently and in compliance with company policies and federal regulations.
Essential Duties and Responsibilities
• Claims Management: Receive, review, and process freight loss and damage claims in accordance with company policies and industry regulations.
• Investigation and Documentation: Collect all supporting documentation, including photos, inspection reports, and terminal or driver statements, to thoroughly evaluate each claim.
• Communication and Resolution: Maintain clear and professional communication with customers, internal departments, and third parties throughout the claims process.
• Reporting and Analysis: Track claim data, analyze trends, and identify areas for process improvement or risk mitigation.
• Compliance and Recordkeeping: Ensure all claims are handled in compliance with applicable laws and carrier liability rules while maintaining accurate digital records within the TMS system.
• Collaboration: Partner with operations and leadership teams to recommend corrective actions that prevent recurring claim issues.
Skills & Attributes
• Strong analytical and investigative skills with excellent attention to detail.
• Exceptional written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook); experience with TMS or claims software preferred.
• Knowledge of LTL operations, NMFC classifications, and cargo liability principles is highly desirable.
• Strong organizational and problem-solving abilities with a customer service mindset.
Requirements Minimum Requirements
· Education: High school diploma or equivalent required; Associate's or Bachelor's degree in Business, Logistics, or a related field preferred.
· Experience: Minimum of 2 years of experience in freight claims, transportation, logistics, or a related administrative role.
Compensation
· Compensation: $20.00 - $24.00 per hour, based on experience and location.
· Classification: Non-Exempt, subject to all applicable state and federal laws.
Work Environment
This is a full-time, at-will position with typical work hours scheduled from Monday to Friday, 8:00 a.m. to 5:00 p.m.
Physical Requirements:
· Prolonged periods of sitting at a desk and working on a computer
· Frequent walking throughout the facility and between departments as part of daily operational tasks
· Ability to lift and/or move up to 20-25 pounds.
· Ability to navigate each department and the company's facilities as needed.
Equal Opportunity Employer
Mountain Valley Express is an at-will and equal opportunity employer. We are committed to employing and assigning the best-qualified candidates without discrimination based on race, color, religion, gender, marital status, age, national origin, physical or mental disability, sexual orientation, veteran/reserve and National Guard status, or any other status or characteristic protected by law.
Salary Description $20.00 - $24.00
$20-24 hourly 60d+ ago
CLAIMS SPECIALIST
Mountain Valley Express 2.9
Mira Loma, CA jobs
Description:ClaimsSpecialist - Job Description
Jurupa Valley, CA - Onsite
Who We Are
Mountain Valley Express (MVE) is a leading LTL Carrier and 3PL Services provider with locations across California, Arizona, and Nevada.
With years of experience, a dedicated team, and cutting-edge technology, MVE offers a broad range of services, including less-than-truckload (LTL), full truckload, custom invoicing and auditing, optimization, warehousing and distribution, engineering solutions, and packaging and shipping supplies. Our deep understanding of the market, along with strong carrier partnerships, allows us to deliver highly tailored services that meet the unique needs of our customers.
Benefits
· Comprehensive medical, dental, and vision insurance.
· 401(k) plan with company match.
· Company-paid Life and AD&D Insurance policies.
· Paid vacation, sick leave, and holidays.
The Opportunity
We are seeking a ClaimsSpecialist to join our team. In this role, you will be responsible for managing the end-to-end freight claims process, including receipt, investigation, documentation, and resolution. This position is integral to maintaining MVE's reputation for accuracy, transparency, and customer service excellence. You will work closely with the Operations, Customer Service, and Accounting teams to ensure claims are resolved efficiently and in compliance with company policies and federal regulations.
Essential Duties and Responsibilities
• Claims Management: Receive, review, and process freight loss and damage claims in accordance with company policies and industry regulations.
• Investigation and Documentation: Collect all supporting documentation, including photos, inspection reports, and terminal or driver statements, to thoroughly evaluate each claim.
• Communication and Resolution: Maintain clear and professional communication with customers, internal departments, and third parties throughout the claims process.
• Reporting and Analysis: Track claim data, analyze trends, and identify areas for process improvement or risk mitigation.
• Compliance and Recordkeeping: Ensure all claims are handled in compliance with applicable laws and carrier liability rules while maintaining accurate digital records within the TMS system.
• Collaboration: Partner with operations and leadership teams to recommend corrective actions that prevent recurring claim issues.
Skills & Attributes
• Strong analytical and investigative skills with excellent attention to detail.
• Exceptional written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook); experience with TMS or claims software preferred.
• Knowledge of LTL operations, NMFC classifications, and cargo liability principles is highly desirable.
• Strong organizational and problem-solving abilities with a customer service mindset.
Requirements:Minimum Requirements
· Education: High school diploma or equivalent required; Associate's or Bachelor's degree in Business, Logistics, or a related field preferred.
· Experience: Minimum of 2 years of experience in freight claims, transportation, logistics, or a related administrative role.
Compensation
· Compensation: $20.00 - $24.00 per hour, based on experience and location.
· Classification: Non-Exempt, subject to all applicable state and federal laws.
Work Environment
This is a full-time, at-will position with typical work hours scheduled from Monday to Friday, 8:00 a.m. to 5:00 p.m.
Physical Requirements:
· Prolonged periods of sitting at a desk and working on a computer
· Frequent walking throughout the facility and between departments as part of daily operational tasks
· Ability to lift and/or move up to 20-25 pounds.
· Ability to navigate each department and the company's facilities as needed.
Equal Opportunity Employer
Mountain Valley Express is an at-will and equal opportunity employer. We are committed to employing and assigning the best-qualified candidates without discrimination based on race, color, religion, gender, marital status, age, national origin, physical or mental disability, sexual orientation, veteran/reserve and National Guard status, or any other status or characteristic protected by law.
$20-24 hourly 10d ago
Claims Specialist
Mountain Valley Express 2.9
Manteca, CA jobs
Full-time Description ClaimsSpecialist - Job Description
Manteca, CA - Onsite
Who We Are
Mountain Valley Express (MVE) is a leading LTL Carrier and 3PL Services provider with locations across California, Arizona, and Nevada.
With years of experience, a dedicated team, and cutting-edge technology, MVE offers a broad range of services, including less-than-truckload (LTL), full truckload, custom invoicing and auditing, optimization, warehousing and distribution, engineering solutions, and packaging and shipping supplies. Our deep understanding of the market, along with strong carrier partnerships, allows us to deliver highly tailored services that meet the unique needs of our customers.
Benefits
· Comprehensive medical, dental, and vision insurance.
· 401(k) plan with company match.
· Company-paid Life and AD&D Insurance policies.
· Paid vacation, sick leave, and holidays.
The Opportunity
We are seeking a ClaimsSpecialist to join our team. In this role, you will be responsible for managing the end-to-end freight claims process, including receipt, investigation, documentation, and resolution. This position is integral to maintaining MVE's reputation for accuracy, transparency, and customer service excellence. You will work closely with the Operations, Customer Service, and Accounting teams to ensure claims are resolved efficiently and in compliance with company policies and federal regulations.
Essential Duties and Responsibilities
• Claims Management: Receive, review, and process freight loss and damage claims in accordance with company policies and industry regulations.
• Investigation and Documentation: Collect all supporting documentation, including photos, inspection reports, and terminal or driver statements, to thoroughly evaluate each claim.
• Communication and Resolution: Maintain clear and professional communication with customers, internal departments, and third parties throughout the claims process.
• Reporting and Analysis: Track claim data, analyze trends, and identify areas for process improvement or risk mitigation.
• Compliance and Recordkeeping: Ensure all claims are handled in compliance with applicable laws and carrier liability rules while maintaining accurate digital records within the TMS system.
• Collaboration: Partner with operations and leadership teams to recommend corrective actions that prevent recurring claim issues.
Skills & Attributes
• Strong analytical and investigative skills with excellent attention to detail.
• Exceptional written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook); experience with TMS or claims software preferred.
• Knowledge of LTL operations, NMFC classifications, and cargo liability principles is highly desirable.
• Strong organizational and problem-solving abilities with a customer service mindset.
Requirements Minimum Requirements
· Education: High school diploma or equivalent required; Associate's or Bachelor's degree in Business, Logistics, or a related field preferred.
· Experience: Minimum of 2 years of experience in freight claims, transportation, logistics, or a related administrative role.
Compensation
· Compensation: $20.00 - $24.00 per hour, based on experience and location.
· Classification: Non-Exempt, subject to all applicable state and federal laws.
Work Environment
This is a full-time, at-will position with typical work hours scheduled from Monday to Friday, 8:00 a.m. to 5:00 p.m.
Physical Requirements:
· Prolonged periods of sitting at a desk and working on a computer
· Frequent walking throughout the facility and between departments as part of daily operational tasks
· Ability to lift and/or move up to 20-25 pounds.
· Ability to navigate each department and the company's facilities as needed.
Equal Opportunity Employer
Mountain Valley Express is an at-will and equal opportunity employer. We are committed to employing and assigning the best-qualified candidates without discrimination based on race, color, religion, gender, marital status, age, national origin, physical or mental disability, sexual orientation, veteran/reserve and National Guard status, or any other status or characteristic protected by law.
Salary Description $20.00 - $24.00
$20-24 hourly 60d+ ago
CLAIMS SPECIALIST
Mountain Valley Express 2.9
Manteca, CA jobs
Description:ClaimsSpecialist - Job Description
Manteca, CA - Onsite
Who We Are
Mountain Valley Express (MVE) is a leading LTL Carrier and 3PL Services provider with locations across California, Arizona, and Nevada.
With years of experience, a dedicated team, and cutting-edge technology, MVE offers a broad range of services, including less-than-truckload (LTL), full truckload, custom invoicing and auditing, optimization, warehousing and distribution, engineering solutions, and packaging and shipping supplies. Our deep understanding of the market, along with strong carrier partnerships, allows us to deliver highly tailored services that meet the unique needs of our customers.
Benefits
· Comprehensive medical, dental, and vision insurance.
· 401(k) plan with company match.
· Company-paid Life and AD&D Insurance policies.
· Paid vacation, sick leave, and holidays.
The Opportunity
We are seeking a ClaimsSpecialist to join our team. In this role, you will be responsible for managing the end-to-end freight claims process, including receipt, investigation, documentation, and resolution. This position is integral to maintaining MVE's reputation for accuracy, transparency, and customer service excellence. You will work closely with the Operations, Customer Service, and Accounting teams to ensure claims are resolved efficiently and in compliance with company policies and federal regulations.
Essential Duties and Responsibilities
• Claims Management: Receive, review, and process freight loss and damage claims in accordance with company policies and industry regulations.
• Investigation and Documentation: Collect all supporting documentation, including photos, inspection reports, and terminal or driver statements, to thoroughly evaluate each claim.
• Communication and Resolution: Maintain clear and professional communication with customers, internal departments, and third parties throughout the claims process.
• Reporting and Analysis: Track claim data, analyze trends, and identify areas for process improvement or risk mitigation.
• Compliance and Recordkeeping: Ensure all claims are handled in compliance with applicable laws and carrier liability rules while maintaining accurate digital records within the TMS system.
• Collaboration: Partner with operations and leadership teams to recommend corrective actions that prevent recurring claim issues.
Skills & Attributes
• Strong analytical and investigative skills with excellent attention to detail.
• Exceptional written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook); experience with TMS or claims software preferred.
• Knowledge of LTL operations, NMFC classifications, and cargo liability principles is highly desirable.
• Strong organizational and problem-solving abilities with a customer service mindset.
Requirements:Minimum Requirements
· Education: High school diploma or equivalent required; Associate's or Bachelor's degree in Business, Logistics, or a related field preferred.
· Experience: Minimum of 2 years of experience in freight claims, transportation, logistics, or a related administrative role.
Compensation
· Compensation: $20.00 - $24.00 per hour, based on experience and location.
· Classification: Non-Exempt, subject to all applicable state and federal laws.
Work Environment
This is a full-time, at-will position with typical work hours scheduled from Monday to Friday, 8:00 a.m. to 5:00 p.m.
Physical Requirements:
· Prolonged periods of sitting at a desk and working on a computer
· Frequent walking throughout the facility and between departments as part of daily operational tasks
· Ability to lift and/or move up to 20-25 pounds.
· Ability to navigate each department and the company's facilities as needed.
Equal Opportunity Employer
Mountain Valley Express is an at-will and equal opportunity employer. We are committed to employing and assigning the best-qualified candidates without discrimination based on race, color, religion, gender, marital status, age, national origin, physical or mental disability, sexual orientation, veteran/reserve and National Guard status, or any other status or characteristic protected by law.
$20-24 hourly 9d ago
Claims Specialist I/Government (Full-time)
Billings Clinic 4.5
Billings, MT jobs
You'll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet Recognition consecutively since 2006.
And you'll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine!
You can make a difference here.
About Us
Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital. Learn more about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality.
Your Benefits
We provide a comprehensive and competitive benefits package to all full- and part-time employees (minimum of 20 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more. Click here for more information or download the Employee Benefits Guide.
Magnet: Commitment to Nursing Excellence
Billings Clinic is proud to be recognized for nursing excellence as a Magnet-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years. Click here to learn more!
Pre-Employment Requirements
All new employees must complete several pre-employment requirements prior to starting. Click here to learn more!
ClaimsSpecialist I/Government (Full-time)
PATIENT FINANCIAL SERVICES - 120.8855 (ROCKY MOUNTAIN PROFESSIONAL BUILDING)
req10854
Shift: Day
Employment Status: Full-Time (.75 or greater)
Hours per Pay Period: 1.00 = 80 hours every two weeks (Non-Exempt)
Starting Wage DOE: $17.00 - 21.25
The ClaimSpecialist's main focus is to obtain maximum and appropriate reimbursement for all claims from government and third-party payers. The ClaimsSpecialist is responsible for preparing and submitting timely and accurate insurance claims to government and third-party payers, assisting in the implementation of payer regulations and ensuring compliance to the regulatory requirements, and verifying payments and adjustments are appropriately applied to accounts based on government, contract or other regulations or agreements. The ClaimsSpecialist is responsible for appropriate follow up on all accounts pending payment from government and third-party payers.
Essential Job Functions
* Supports and models behaviors consistent with the mission and philosophy of Billings Clinic and department/service.
* Responsible for submission of timely and accurate claims to primary, secondary, and tertiary insurances for both electronic and paper submission. Generates telephone calls to insurance carriers to follow up on insurance using reports generated for this purpose to ensure the timely collection of money due on the account.
* Audits accounts by verifying that reimbursement amounts are appropriate, coordination of refunds, if appropriate, and coordinating adjustments when necessary, claims appeals or resubmissions, moving balances from insurance responsibility to patient responsibility when appropriate, and reviews and resolves credit balances.
* Ensure that claims have appropriate information on them for submission to insurance companies or agencies by reviewing errors and other prebilling insurance reports/worklists. Analyzes and review claims to ensure that payer specific regulations and requirements are met.
* Prepares and presents verbally and in writing challenges to third party payers for additional reimbursement for denied charges and/or reductions in reimbursement as appropriate.
* Provides guidance and or assistance to the cashiers.
* Provides timely follow-up on correspondence received from the insurance carrier or patient.
* Responds to inquiries from customers/other departments/insurance carriers regarding insurance coverage issues, coordination of benefits, reconciliation of account balances and complaints regarding services received. Initiates appropriate follow-up on outstanding issues.
* Sets up registration and insurance information when necessary.
* Utilizes performance improvement principles to assess and improve quality.
* Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements.
* Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance.
* Performs other duties as assigned or needed to meet the needs of the department/organization.
Minimum Qualifications
Education
* High School or GED
Experience
* One year of previous office experience
* Patient accounts or insurance billing experience preferred
Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered
Billings Clinic is Montana's largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more at ******************************
Billings Clinic is committed to being an inclusive and welcoming employer, that strives to be kind, safe, and courageous in all we do. As an equal opportunity employer, our policies and processes are designed to achieve fair and equitable treatment of all employees and job applicants. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, religion, sex, gender identity, sexual orientation, pregnancy, marital status, national origin, age, genetic information, military status, and/or disability. To ensure we provide an accessible candidate experience for prospective employees, please let us know if you need any accommodations during the recruitment process.
$17-21.3 hourly 60d+ ago
Learn more about Providence Health & Services jobs