Job Description
Department(s): Claims Administration
Reports to: Supervisor, Claims (Data Entry/ Mailroom)
FLSA status: Non-Exempt
Salary Grade: A - $20.00 - $25.79 ($41,600 - 53,636)
About CalOptima Health
CalOptima Health is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima Health.
About the Position
The Data Entry Tech (Claims) will ensure consistent and efficient mailroom operations and assist with the day-to-day mailroom responsibilities. The incumbent will perform all mailroom operations and will be responsible for opening, date stamping and triaging all incoming mail and Provider Dispute Resolution forms (PDRs).
Duties & Responsibilities:

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Sorts all incoming mail, counted by claim type and prepared to be sent to the imaging vendor
• Prepares, date stamps all Certified and FedEx mail and logs in a timely manner.
• Copies all Certified and FedEx mail envelopes attached to the original document.
• Delivers mail to the general mailroom to be mailed out twice per day.
• Maintains a daily log of all misdirected PDR forms and places them in the Grievance and Appeals Resolution Services (GARS) bin for pick up.
• Performs regularly scheduled morning and afternoon mail deliveries in a timely and consistent manner.
• Keeps the mailroom area neat and free from clutter, maximizing safety and efficiency.
• Alerts supervisor of any issues that impact production and quality.
• Reviews rejected claim files received from vendor and determines appropriate course of action.
• Sends misrouted claims to the appropriate group within ten business days.
• Ensures all Protected Healthcare Information (PHI) is locked at the end of the day.
• Completes other projects and duties as assigned.

Experience & Education:

• High School diploma or equivalent required.
• 1 year of data entry experience required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• Mailroom experience in claims operation within a managed care or health care industry.

Physical Demands and Work Environment:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings and face-to-face interaction.

• Work Environment: Employee will work in an office environment with minimal to moderate noise levels and controlled office temperatures.

About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
Job Location: Orange, California
Position Type:
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4307
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