**The position is a phone position requiring the candidates to answer calls for 7.5 hours a day.


**This is not an Examiner/Adjuster position.


**The position is a Temp a position,


Department: Claims Administration


$25.87 - $38.8077


Duties & Responsibilities:


80% - Claims Support


Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or Company agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures.


Follows up with providers as needed.


15% - Administrative Support


Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.


Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.


Ensures accurate and timely documentation regarding all issues, and/or inquiries are entered in Facets.


Routes escalated calls to the appropriate departments and/or management.


5% - Completes other duties or projects as assigned.


Minimum Qualifications:


High School diploma or equivalent required.


2 years of experience in claims resolution required.


1 year of call center experience with high call volumes or customer service experience required.


1 year of HMO, Medi-Cal/Medicaid and healthcare/managed care experience required.


An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.


Preferred Qualifications:


Required Licensure / Certifications


Knowledge & Abilities:


Develop rapport and establish and maintain effective working relationships with Company leadership and staff and external contacts at all levels and with diverse backgrounds


Work independently and exercise sound judgment.


Communicate clearly and concisely, both orally and in writing.


Work a flexible schedule; available to participate in evening and weekend events


Organize, be analytical, problem-solve and possess project management skills


Work in a fast-paced environment and in an efficient manner.


Manage multiple projects and identify opportunities for internal and external collaboration.


Motivate and lead multi-program teams and external committees/coalitions.


Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment


All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county, to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.