Top 54 Claims representative Jobs in Fairfield, Ca

Claims Customer Service Representative I
Partnership HealthPlan of California —Fairfield, CA
- $29.95 - $35.19 an hour
- Full-time
- Computer literacy
- Research
- High school diploma or GED
Claims Resolution Coordinator
Partnership HealthPlan of California —Fairfield, CA
- $37.22 - $46.53 an hour
- Full-time
- Computer literacy
- Mid-level
- Office
Claims Examiner II
Partnership HealthPlan of California —Fairfield, CA
- $31.45 - $37.74 an hour
- Research
- Mid-level
- Office
Cost Avoidance Specialist I
Partnership HealthPlan of California —Fairfield, CA
- $80,140.53 - $100,175.67 a year
- Computer literacy
- Writing skills
- Research
Claims Representative (IAP): Workers Compensation Training Program | Concord, CA
Sedgwick —Concord, CA
- Full-time
- Customer service
- No experience needed
- Office
- Health savings account
- Disability insurance
Revenue Cycle Manager
Medic Ambulance Service —Fairfield, CA
- $140,000 - $180,000 a year
- Online Application
- Microsoft Excel
- HIPAA
- Office
- Health insurance
- Dental insurance
Quick Apply
14d
Customer Service Representative - State Farm Agent Team Member
Rena Macdonald - State Farm Agent —Fairfield, CA
- $25 - $35 an hour
- Full-time
- Sales
- Office
- Communication skills
- Health insurance
- Dental insurance
Quick Apply
Patient Account Representative III Hospital Billing Unit
Northbay Healthcare —Fairfield, CA
- $32.15 - $39.02 an hour
- 8 hour shift
- Hybrid work
- Word processing
- Computer literacy
- Mid-level
- 403(b) matching
- Health insurance
Patient Access Ambassador II (Per Diem, Evening)
Northbay Healthcare —Fairfield, CA
- $33.23 an hour
- 8 hour shift
- Hybrid work
- Customer service
- Writing skills
- Mid-level
- 403(b) matching
- Health insurance
Senior Claims Examiner
Athens Administrators —Concord, CA
- $50.29 - $55.87 an hour
- Urgently hiring
- Management
- Bachelor of Science
- Basic math
- Health savings account
- AD&D insurance
Quick Apply
11d
Property Claims Specialist Field I - Tracy, Livermore, San Jose, Pleasanton
Mercury Insurance Services, LLC —Concord, CA
- $63,410 - $117,348 a year
- Overtime
- Bilingual
- Military
- Writing skills
- Paid holidays
- Health insurance
Patient Access Representative (Per Diem)
Sonoma Valley Hospital —Sonoma, CA
- $26.95 - $35.03 an hour
- Per diem
- Bilingual
- Hospital
- High school diploma or GED
Patient Access Representative
Sonoma Valley Hospital —Sonoma, CA
- $23.43 - $30.47 an hour
- Full-time
- Bilingual
- Hospital
- High school diploma or GED
Patient Account Representative III Pro Fee (On-Site, Hybrid, Remote)
Northbay Healthcare —Fairfield, CA
- $32.51 an hour
- Full-time
- Hybrid work
- Word processing
- Computer literacy
- 11+ years
- 403(b) matching
- Health insurance
1d
Multi-Line Representative - State Farm Agent Team Member
Gigi Horton - State Farm Agent —Fairfield, CA
- $36,000 - $100,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Paid time off
Quick Apply
Senior Health Data Analyst I
Partnership HealthPlan of California —Fairfield, CA
- $106,667.05 - $138,667.16 a year
- Full-time
- Microsoft Office
- Master's degree
- SQL
Medical & Dental Billing Clerk and Administrative Assistant
Winters Health Care —Winters, CA
- $24.75 - $38.80 an hour
- 8 hour shift
- Spanish
- Microsoft Excel
- Microsoft Outlook
- AD&D insurance
- Paid holidays
7d
Claims Supervisor
Athens Administrators —Concord, CA
- $119,000 - $132,000 a year
- Urgently hiring
- Bachelor of Science
- Employment & labor law
- Mid-level
- Health savings account
- AD&D insurance
Quick Apply
Patient Services Rep (Part Time, Days)
Northbay Healthcare —Vacaville, CA
- $26.92 an hour
- Full-time
- Hybrid work
- BLS Certification
- HIPAA
- Mid-level
- 403(b) matching
- Health insurance
1d
Multi-Line Representative - State Farm Agent Team Member
Corina Marler - State Farm Agent —Fairfield, CA
- $50,000 - $75,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Health insurance
- Dental insurance
Quick Apply

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Claims Customer Service Representative I

Partnership HealthPlan of California -
Fairfield, CA

Apply Now

Job Details

Full-time
$29.95 - $35.19 an hour

Qualifications

Customer communication
Computer literacy

Full Job Description

Overview:

To research and resolve provider telephone and written inquiries within established time frames, accurately screen claims, and participate in provider meetings and projects. To accurately research and process paper and electronic medical, outpatient, ancillary, long term care, CHDP, encounter data and paper crossover/other coverage claims within established time frames, applying appropriate program policies related to claims processing and analysis.

Responsibilities:

Responds to provider telephone inquiries, researches policy issues, and analyzes EOP's and claim history, recommends resolution to the issues, implements resolution once approved.
Researches and communicates outcome to providers of CIF's, claim tracers, and general claim correspondence within established time frames
Follows established Partnership policies and procedures, Partnership claims operating instruction memorandums, EDS provider manual guidelines, and Title 22 regulations when resolving claims and claim issues.
Participates in provider meetings to resolve claim issues.
Recognizes and gives feedback to management on procedure changes that would result in more efficient operations.
Records daily production statistics and related activities on appropriate reports; turns all logs and reports in to Claims Customer Service Supervisor.
Meets established production and call performance metrics as determined.
Participates in special projects and assignments as required.
Participates in resolution of CIFs as required.
Other duties as assigned.

Qualifications:

Education and Experience

High school diploma or equivalent; one (1) year of prior claims processing experience in an automated claim environment preferred; or equivalent combination of education and experience.

Special Skills, Licenses and Certifications

Knowledge of CPT, HCPC procedure coding, and ICD-10 diagnostic coding. Knowledge of medical terminology preferred. Ability to access coding reference guides for accurate information. Typing speed 30 wpm and proficient use of 10-key calculator.

Performance Based Competencies

Excellent written and oral communication skills. Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy. Good organizational skills. Ability to accurately complete tasks within established time frames.

Work Environment And Physical Demands

Ability to use a computer keyboard. More than 80% of work time is spent in front of a computer monitor; when required, ability to move, carry, or lift objects of varying size weighing up to 25 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:

$ 29.95 - $ 35.19

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.

Apply Now

Refine Your Search

claims representative jobs in fairfield, ca

Claims Customer Service Representative I

Claims Resolution Coordinator

Claims Examiner II

Cost Avoidance Specialist I

Claims Representative (IAP): Workers Compensation Training Program | Concord, CA

Revenue Cycle Manager

Customer Service Representative - State Farm Agent Team Member

Patient Account Representative III Hospital Billing Unit

Patient Access Ambassador II (Per Diem, Evening)

Senior Claims Examiner

Property Claims Specialist Field I - Tracy, Livermore, San Jose, Pleasanton

Patient Access Representative (Per Diem)

Patient Access Representative

Patient Account Representative III Pro Fee (On-Site, Hybrid, Remote)

Multi-Line Representative - State Farm Agent Team Member

Senior Health Data Analyst I

Medical & Dental Billing Clerk and Administrative Assistant

Claims Supervisor

Patient Services Rep (Part Time, Days)

Multi-Line Representative - State Farm Agent Team Member

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