Top 86 Customer relations representative Jobs in Antioch, Ca

Claims Resolution Coordinator
Partnership HealthPlan of California —Fairfield, CA
- $37.22 - $46.53 an hour
- Full-time
- Computer literacy
- Mid-level
- Office
Dispatcher
Durham School Services —Concord, CA
- $36.50 an hour
- Full-time
- Bilingual
- Mid-level
- High school diploma or GED
- Paid holidays
- Health insurance
Quick Apply
Pension Call Center Representative
UFCW EMPLOYERS BENEFITS PLANS OF NORTHERN CA —Concord, CA
- $32.66 an hour
- Full-time
- Background check
- Word processing
- Pass drug screening
- Free parking
- Health insurance
Quick Apply
EXECUTIVE CHEF 1- Executive Chef 1 UC Berkeley Greek House Chefs
GREEK HOUSE CHEFS INC —Berkeley, CA
- $60,000 - $65,000 a year
- ServSafe
- English
- Ability to lift 50 pounds
Quick Apply
Pharmacy Manager/Pharmacist in Charge
CVS Health —Walnut Creek, CA
- $65.73 - $79.16 an hour
- Weekends as needed
- Mid-level
- Travel
- Military encouraged
- Health savings account
- Health insurance
Quick Apply
Entry Level Customer Representative
All For One Group, Inc. —Lafayette, CA
- $52,000 - $60,000 a year
- Full-time
- High school diploma or GED
- In-person
- Entry level
- Professional development assistance
Quick Apply
6d
Territory Sales Representative
Inizio Engage —Walnut Creek, CA
- $105,000 - $195,000 a year
- Full-time
- Background check
- Mid-level
- Bachelor's degree
- Paid parental leave
- Paid holidays
3d
Senior Sales Account Manager-Northern California
Smithfield Foods —California
- $85,000 - $120,000 a year
- Full-time
- Ability to walk for extended periods
- Product management
- Travel
- Relocation assistance
ADMISSIONS COORDINATOR
O'Connor Woods —Stockton, CA
- $33 - $35 an hour
- Skilled nursing facility
- Mid-level
- Computer skills
Quick Apply
Customer Service Representative - Rio Vista - 25 Hours
Farmers & Merchants Bank of Central California —Rio Vista, CA
- $20 - $23 an hour
- Part-time
- Spanish
- High school diploma or GED
- 1 year
Quick Apply
FRONT DESK RECEPTIONIST (TEMPORARY 6 MONTHS)
Axis Community Health —Pleasanton, CA
- $24 an hour
- Full-time
- Spanish
- Writing skills
- HIPAA
- 403(b) matching
- Paid holidays
Front Desk Coordinator and Administrative Assistant
Dance Studio —Walnut Creek, CA
- $18 - $22 an hour
- Part-time
- Microsoft Excel
- Merchandising
- Office
- Flexible schedule
Quick Apply
Purchasing Agent
Contra Costa Electric, Inc. —Martinez, CA
- $30 - $40 an hour
- Weekends as needed
- Writing skills
- English
- Mid-level
- Paid holidays
- Health insurance
New Accounts Representative- Full-Time
Oak Valley Community Bank —Stockton, CA
- $19.71 - $26.44 an hour
- Full-time
- Writing skills
- Basic math
- Office
- Health insurance
- Dental insurance
Quick Apply
Account Representative - State Farm Agent Team Member
Brian Haghighi - State Farm Agency Intern —Concord, CA
- $20 - $30 an hour
- Part-time
- Office
- Communication skills
- Entry level
- Opportunities for advancement
- Flexible schedule
Quick Apply
Store Manager
Ross Stores —Pittsburg, CA
- $70,310 - $102,578 a year
- Weekends as needed
- 5 years
- Merchandising
- English
12d
Patient Care Coordinator
Specialty1 Partners —Lafayette, CA
- $25 - $29 an hour
- Dental office
- High school diploma or GED
- Critical & Intensive Care
- Health savings account
- Disability insurance
Quick Apply
COMMUNITY HEALTH WORKER
Axis Community Health —Pleasanton, CA
- $26 - $28 an hour
- Full-time
- Spanish
- Clean driving record
- Writing skills
- 403(b) matching
- Paid holidays
Operational Branch Services Officer
WESTAMERICA BANK —Walnut Creek, CA
- $16.90 - $23.51 an hour
- Full-time
- Ability to walk for extended periods
- Basic math
- Mid-level
Quick Apply
Lending Advisor Associate
Mechanics Bank —Walnut Creek, CA
- $24.80 - $42.15 an hour
- Full-time
- Writing skills
- Mid-level
- Office
- Free parking
- Commuter assistance

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Claims Resolution Coordinator

Partnership HealthPlan of California -
Fairfield, CA

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Job Details

Full-time
$37.22 - $46.53 an hour

Qualifications

ICD-9
Driver's License
Typing

Full Job Description

Overview:

To research and resolve complex claims issues which cross interdepartmental lines and communicate the outcome to providers and affected Partnership managers. Develops and maintains provider training materials for all lines of business. Conducts provider trainings across Partnership departmental lines in group or individual provider settings.

Responsibilities:

Answers customer service lines as necessary and responds to provider inquiries either by phone, email, or in person regarding claims related questions.
Reviews, researches, and works with various departments to resolve complex provider inquiries, appeals, and grievances.
Acts as a resource and provides support to customer service staff, as well as Provider Relations staff for complex Provider questions regarding claims and payments.
Coordinates with Claims, Member Services, Health Services departments, the development, maintenance, and training of ongoing educational materials and tips for inclusion on the PHC website. Incorporates educational materials into the PR Manual and update on a quarterly basis.
Processes CIF's and adjustments as needed.
Writes and runs reports in Business Objects to obtain needed claim data.
Tracks and analyzes provider trends with denials and CIF's to provide support to providers with an opportunity to improve. Distributes provider scorecards.
Tracks complaints, appeals, and grievances by program. Reports activities on a quarterly basis to IQI, PHC Compliance Coordinator, and Claims Director.
Presents findings and recommendations for ongoing, long term resolutions to issues. Identifies items to address the “provider hassle factor.”
Acts as liaison and meets with designated staff from Claims, Health Services, Member Services, and QI departments to identify ongoing provider issues.
Coordinates system issues with Claims Configuration staff, IT staff, and PR Lead Project Specialist/Auditor. Leads or participates in special projects as needed.
Other duties as assigned

Qualifications:

Education and Experience

Minimum 1 year of experience in claims examining or customer service within healthcare, insurance, finance, or managed care environment; or equivalent combination of relevant experience and education.

Special Skills, Licenses and Certifications

Familiarity with Medi-Cal and/or managed care claims processing. Knowledge of CPT, HCPC procedure coding, and ICD-9 diagnostic coding. Knowledge of Partnership Claim Policy and Procedures, Medi-Cal provider manual guidelines, Title 22 regulations and any other required policies, procedures, regulations, and manuals. Typing speed 30 wpm and proficient use of 10-key calculator. Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business .

Performance Based Competencies

Ability to analyze and research claims issues. Excellent written and oral communication skills. Ability to present statistical and technical data in a clear and understandable manner. Good organization skills. Ability to work on multiple assignments simultaneously, prioritize work and complete projects within established time frames. Use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.

Work Environment And Physical Demands

Ability to use a computer keyboard. More than 60% of work time is spent in front of a computer monitor. When required, ability to move, carry or list objects of varying size, weighing up to 5 lbs.

All HealthPlan employees are expected to:

Provide the highest possible level of service to clients;
Promote teamwork and cooperative effort among employees;
Maintain safe practices; and
Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$ 37.22 - $ 46.53

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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Refine Your Search

customer relations representative jobs in antioch, ca

Claims Resolution Coordinator

Dispatcher

Pension Call Center Representative

EXECUTIVE CHEF 1- Executive Chef 1 UC Berkeley Greek House Chefs

Pharmacy Manager/Pharmacist in Charge

Entry Level Customer Representative

Territory Sales Representative

Senior Sales Account Manager-Northern California

ADMISSIONS COORDINATOR

Customer Service Representative - Rio Vista - 25 Hours

FRONT DESK RECEPTIONIST (TEMPORARY 6 MONTHS)

Front Desk Coordinator and Administrative Assistant

Purchasing Agent

New Accounts Representative- Full-Time

Account Representative - State Farm Agent Team Member

Store Manager

Patient Care Coordinator

COMMUNITY HEALTH WORKER

Operational Branch Services Officer

Lending Advisor Associate

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