Top 37 Claims customer service representative i Jobs in Vacaville Ca

Claims Resolution Coordinator
Partnership HealthPlan of California —Fairfield, CA
- $37.22 - $46.53 an hour
- Full-time
- Computer literacy
- Mid-level
- Office
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
Veterans Service Representative I
County of Contra Costa, California —Martinez, CA
- $76,344.71 - $92,797.46 a year
- Full-time
- Office
- Analysis skills
- Bachelor's degree
6d
Claims Investigator - Full Time
Command Investigations, LLC —Rio Vista, CA
- $23 - $30 an hour
- Overtime
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
7d
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
Patient Services Rep, Neurology (Per Diem, Days)
Northbay Healthcare —Fairfield, CA
- $26 an hour
- Full-time
- Hybrid work
- BLS Certification
- Mid-level
- Neurology
- 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
Patient Services Rep (Full Time, Days) Neurosurgery Clinic
Northbay Healthcare —Fairfield, CA
- $26 an hour
- Full-time
- Hybrid work
- BLS Certification
- HIPAA
- Mid-level
- 403(b) matching
- Health insurance
Claims Trainer
Partnership HealthPlan of California —Fairfield, CA
- $33.65 - $40.38 an hour
- Full-time
- Mid-level
- Office
- Driver's License
Construction Claims Representative
Titan Workforce LCC —Vallejo, CA
- $75,000 a year
- Urgently hiring
- Background check
- Construction site
- Computer literacy
- Health insurance
- Dental insurance
5d
Multi-Line Representative - State Farm Agent Team Member
Gigi Horton - State Farm Agent —Fairfield, CA
- $40,000 - $60,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Paid time off
Quick Apply
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
Community Manager II Night Manager (Temporary 6 month assignment) - Woodside Court, Fairfield
Eden Housing —Fairfield, CA
- $25.02 - $29.36 an hour
- Full-time
- CPR Certification
- Sanitation
- English
Quick Apply
12d
Customer Service Representative - State Farm Agent Team Member
Marissa Johnson - State Farm Agent —Napa, CA
- $25 - $35 an hour
- Full-time
- Windows
- Computer skills
- Communication skills
- Health insurance
- Dental insurance
Quick Apply
Public Works Inspector I/II
City of Davis, CA —Davis, CA
- $76,075.58 - $101,716.78 a year
- 8 hour shift
- Construction site
- English
- Office
- Paid parental leave
- Paid holidays
Multi-Line Representative - State Farm Agent Team Member
Olimpia Campos Garner - State Farm Agent —Dixon, CA
- $50,000 - $70,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Paid time off
- Opportunities for advancement
Quick Apply
Account Manager - State Farm Agent Team Member
Robert Reed - State Farm Agent —Napa, CA
- $35,000 - $100,000 a year
- Full-time
- Mid-level
- Communication skills
- Paid holidays
- Health insurance
Quick Apply
Valet Supervisor - Napa CA
Parking Management Company —Napa, CA
- Overtime
- Background check
- Mid-level
- High school diploma or GED
- Paid training
- Health insurance
Quick Apply
Project Manager
ARB, Inc —Pittsburg, CA
- $105,000 - $150,000 a year
- Extended hours
- Microsoft Excel
- Microsoft Outlook
- Construction site
- Employee stock purchase plan
- Paid holidays
Quick Apply
10d
Insurance Staff Position - State Farm Agent Team Member
Marissa Johnson - State Farm Agent —Napa, CA
- $25 - $28 an hour
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- Opportunities for advancement
Quick Apply

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Claims Resolution Coordinator

Partnership HealthPlan of California -
Fairfield, CA

Apply Now

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.

Apply Now

Refine Your Search

claims customer service representative i jobs in vacaville ca

Claims Resolution Coordinator

Claims Customer Service Representative I

Veterans Service Representative I

Claims Investigator - Full Time

Revenue Cycle Manager

Patient Services Rep, Neurology (Per Diem, Days)

Patient Access Ambassador II (Per Diem, Evening)

Patient Services Rep (Full Time, Days) Neurosurgery Clinic

Claims Trainer

Construction Claims Representative

Multi-Line Representative - State Farm Agent Team Member

Multi-Line Representative - State Farm Agent Team Member

Community Manager II Night Manager (Temporary 6 month assignment) - Woodside Court, Fairfield

Customer Service Representative - State Farm Agent Team Member

Public Works Inspector I/II

Multi-Line Representative - State Farm Agent Team Member

Account Manager - State Farm Agent Team Member

Valet Supervisor - Napa CA

Project Manager

Insurance Staff Position - State Farm Agent Team Member

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