Provider Services – Claims Specialist

Requisition #20178
Employment Type

Full-time

Experience

Two years Medicare/Commercial claims experience

Location

445 Grant Avenue, San Francisco, CA 94108

Region
Bay Area San Francisco
Application Email
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Brief job information:

A Provider Services specialist is responsible for working with CCHP’s provider network to address claims payment and policy inquiries. This critical member of the Provider services team will manage and resolve a portfolio of cases with medical offices and other healthcare providers.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  1. Managing incoming communications from current healthcare providers
  2. Researching and resolving current claims cases and communicate results
  3. Making outbound calls to obtain required information for claims management or re­ consideration
  4. Helping to identify root causes of claims payment errors
  5. Collaborating with other departments and/or providers in successful resolution of claims related
  6. Generating and developing reports which include but not limited to root causes of claims payment issues
  7. Ensuring all compliance requirements are satisfied and that all payments are made against company practices and procedures
  8. Accepts and performs other duties as assigned.

QUALIFICATIONS

  • Must have worked in healthcare and/or health insurance
  • 2+ years Medicare and/or Commercial claims experience
  • Strong customer service skills
  • Outstanding oral, written and organizational skills
  • Excellent data analysis skills
  • Excels in a team environment – Must be a ‘Proactive’ team player
  • Intermediate with MS Excel and PowerPoint
  • Must be based in SF Bay Area, though remote work is possible

In our efforts to control the spread of COVID-19 and its variants, CCHP requires that its employees be fully vaccinated as of their start date. If you require a medical or religious accommodation we will engage in the interactive process with you. Proof of vaccination will be required prior to start. If we make you an offer and you are not yet vaccinated, we will accommodate a delay in start date. CCHP may also mandate that its employees receive vaccine boosters, and all accommodation laws will be followed.