Top 80 Claims representative Jobs in Pleasanton, Ca

Member Service Representative Level 1 (Pleasanton, CA)
BeneSys, Inc. —Pleasanton, CA
- $34.12 an hour
- Full-time
- Microsoft Word
- Basic math
- High school diploma or GED
- Paid jury duty
- AD&D insurance
Quick Apply
Patient Accounting Representative F/T
Washington Hospital —Fremont, CA
- $33.78 - $41.46 an hour
- 8 hour shift
- Computer literacy
- Mid-level
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Patient Accounting Representative Part Time
Washington Hospital —Fremont, CA
- $35.38 - $43.43 an hour
- 8 hour shift
- Hospital
- Mid-level
Quick Apply
Property & Casualty Claims Advocate
HUB International —San Ramon, CA
- $68,000 - $100,000 a year
- Online Application
- Microsoft Outlook
- Writing skills
- Mid-level
- Health savings account
- Disability insurance
Customer Service Representative - State Farm Agent Team Member
Morgan King - State Farm Agent —Pleasanton, CA
- Full-time
- Communication skills
- Marketing
- Entry level
- Paid time off
- Opportunities for advancement
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Customer Service Representative - State Farm Agent Team Member
Samantha Harris - State Farm Agent —Castro Valley, CA
- $52,000 - $100,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- 401(k)
- Paid time off
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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
Liability Claims Clerk, Professional Liability
BETA HEALTHCARE GROUP RISK MANAGEMENT —Alamo, CA
- $34.36 - $38.46 an hour
- Full-time
- Hybrid work
- Office
- High school diploma or GED
- Data entry
- Work from home
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Property Claims Specialist Field I
Mercury Insurance Services, LLC —Concord, CA
- $63,410 - $117,348 a year
- Overtime
- Bilingual
- Military
- Writing skills
- Paid holidays
- Health insurance
Patient Account Representative I
Stanford Health Care —Palo Alto, CA
- $31.94 - $35.94 an hour
- Full-time
- Writing skills
- Basic math
- High school diploma or GED
10d
Customer Service Representative - State Farm Agent Team Member
Kim Holland - State Farm Agent —Hayward, CA
- $40,000 - $45,000 a year
- Full-time
- Spanish
- Office
- Communication skills
- Paid time off
- Opportunities for advancement
Quick Apply
Pharmacy Service Representative - (Full-Time, 8-Hour Day Shifts/Hybrid)
Stanford Health Care —Palo Alto, CA
- $31.30 - $35.25 an hour
- 8 hour shift
- Microsoft Word
- Microsoft Outlook
- Computer literacy
9d
Customer Service Representative - State Farm Agent Team Member
Yogi Chugh - State Farm Agent —Fremont, CA
- $35,000 - $48,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- 401(k) matching
Quick Apply
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
Multi-Line Representative - State Farm Agent Team Member
Jeff Sinfuego - State Farm Agent —Hayward, CA
- $20 - $30 an hour
- Full-time
- Office
- Organizational skills
- Marketing
- Health insurance
- Paid time off
Quick Apply
Multi-Line Representative - State Farm Agent Team Member
Yogi Chugh - State Farm Agent —Fremont, CA
- $45,000 - $60,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Paid time off
- 401(k) matching
Quick Apply
Health Services Representative
The County of Santa Clara —San Jose, CA
- $66,040.00 - $79,705.60 a year
- Part-time
- Research
- Mid-level
- Typing
- Wellness program
- AD&D insurance
2d
Patient Service Representative
Bay Area Kids Dentist —Sunnyvale, CA
- $21 - $25 an hour
- 8 hour shift
- Dental office
- High school diploma or GED
- Children
- Health insurance
- Dental insurance
Quick Apply
10d
Multi-Line Representative - State Farm Agent Team Member
Katie Brazil - State Farm Agent —Tracy, CA
- $55,000 - $80,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Paid time off
- 401(k) matching
Quick Apply
Account Manager, Personal Lines
HUB International —San Ramon, CA
- Online Application
- Microsoft Outlook
- Writing skills
- Mid-level
- Health savings account
- Disability insurance

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Member Service Representative Level 1 (Pleasanton, CA)

BeneSys, Inc. -
Pleasanton, CA

Quick Apply

Job Details

Full-time
$34.12 an hour

Benefits

Paid jury duty
AD&D insurance
Paid holidays
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Paid time off
Dependent health insurance coverage
Vision insurance
401(k) matching
Union benefits
Bereavement leave

Qualifications

Microsoft Word
Phone communication
High school diploma or GED
Client interaction via phone calls

Full Job Description

Member Service Representative Level 1 (Pleasanton, CA)

Summary - This is a call center environment. Call center experience is required. The Member Service Representative responds to incoming telephone calls from client participants and providers with questions about Health & Welfare benefits. This is a Union position.

Essential Duties and Responsibilities include but not limited to

Positively respond to incoming calls from members and providers by, among other things:
- explaining group benefits
- addressing eligibility questions
- providing information on referrals
- describing required authorizations for medical care
- assisting with claims’ issues
- providing claims’ status
- answering questions or concerns
- resolving problems
Submit requests for adjustments on claims, research questions and problems, and provide the best solutions available.
Alternate with co-workers during slow periods to make sure phones are always covered.
Make outgoing calls to members and providers.
Alpha sorting, organizing, or other special projects.
File forms and letters.
Provide available information upon request and escalate issues as appropriate to Supervisor and/or Manager.
Retain records of calls by documenting in the appropriate system for tracking.
Other duties may be assigned.
Reliable and predictable attendance is an essential function of this job.

Member Services Representative Levels

Level I - Some customer service experience, some claims knowledge, good phone skills, positive attitude, medical knowledge a plus.

Level II - Level I skills, plus complete understanding of BeneSys, Eldorado, Benefit Driven, Well Point, and Envision systems and Plan documents. Knowledge of any vendor systems that may be required to assist in calls. Ability to field 90% of calls without consulting the Unit Leader.
Level III - Level I and II skills, plus complete understanding of all California Plans. Knowledgeable in handling group benefit issues, ability to interpret Plan guidelines. Ability to analyze plans and interpret benefit language contained in Plan documents. Good overall understanding of claims’ processing guidelines to assist with resolving claims’ issues and able to translate these issues clearly for resolution. Good internal technical ability to assist other Team members with internal/external systems. Fielding elevated issues from the Team and assessing the problem and attempting to resolve them prior to referring to the Supervisor or Manager.

Qualifications

Background in medical claims processing.
Call center experience.
Knowledge of medical terminology and understanding of healthcare benefits, definitions and applications.
Knowledge of and capable of handling multiple group benefits.
Ability to communicate clearly with accurate information to callers either by telephone, electronic messaging, or face-to-face interaction.
Ability to deal with people in stressful situations.
Ability to use good communication skills and keen observation to understand what a caller is asking for and then use good judgment to come to a resolution.
Ability to multi-task, respond to questions correctly and accurately and resolve the issue from initial contact with caller.
Ability to diffuse irate calls to a level where the caller is satisfied with the response and resolution is complete.
Ability to work well in a team environment and independently.
Good working knowledge of Microsoft Excel/Word.
Regular and predictable attendance is an essential function of this job.

Education and/or Experience - High School diploma or GED equivalent. Two plus years in an Employee Benefits position or similar.

Language Skills - Effective communication skills are essential. Individual should enjoy and be able to work in a busy and sometimes noisy/high pressured environment.

Mathematical Skills - Ability to apply concepts of basic addition, subtraction, multiplication, and division.

Reasoning Ability - Representative must be analytical and can apply common sense to carry out detailed written or oral instructions. Representative must be able to deduce if a balance due is the responsibility of the member or if the plan has yet to consider the charges.

Physical Demands - Occasional lifting of paperwork and batches of claims. Regular use of standard office equipment such as: computers, phones, photocopiers, fax machines, etc. Sustained periods of being on the telephone, keyboarding, sitting/standing.

Work Environment - The position operates in a typical call center environment, that, at times, can be noisy, pressured and stressful. The department can be fast paced.

Work Schedule - Full time. Monday – Friday, 8:00am - 5:00pm. Required in office (no at-home days).

Competitive Benefits

Medical/Dental/Vision, with option for dependent coverage
Flexible spending accounts
Company-paid basic life/AD&D, short-term disability, long-term disability insurance
15 days Paid Time Off during first full calendar year
11 paid holidays
Up to 5 days of paid bereavement leave
Up to 20 days of paid jury duty leave
401(k) with employer match

Pay

The current starting rate for this position is $34.12. This is a union position. The wage rate for this position is determined by the collective bargaining agreement and may be dependent on experience, skills, education and other business factors.

Our Culture

BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees’ successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential.

Our culture focuses on three core values:

Collaboration: working together across 31 locations to achieve the best for the company and our clients
Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
Integrity: doing what we say we will do. Upholding strong ethical and moral principles

ADA & EEO

Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.

Quick Apply

Refine Your Search

claims representative jobs in pleasanton, ca

Member Service Representative Level 1 (Pleasanton, CA)

Patient Accounting Representative F/T

Patient Accounting Representative Part Time

Property & Casualty Claims Advocate

Customer Service Representative - State Farm Agent Team Member

Customer Service Representative - State Farm Agent Team Member

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

Liability Claims Clerk, Professional Liability

Property Claims Specialist Field I

Patient Account Representative I

Customer Service Representative - State Farm Agent Team Member

Pharmacy Service Representative - (Full-Time, 8-Hour Day Shifts/Hybrid)

Customer Service Representative - State Farm Agent Team Member

Claims Supervisor

Multi-Line Representative - State Farm Agent Team Member

Multi-Line Representative - State Farm Agent Team Member

Health Services Representative

Patient Service Representative

Multi-Line Representative - State Farm Agent Team Member

Account Manager, Personal Lines

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