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FLSA Status: Non-Exempt
Department: Claims
Reports To: Claims Supervisor, Manager, or Director
Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521
The Provider Claim Dispute Analyst manages the Health Plan’s provider claims dispute process and is responsible for following regulatory guidelines and Santa Clara Family Health Plan’s Provider Dispute Resolution (PDR) policy and procedure governing the logging, tracking, acknowledgement, and resolution of claims disputes submitted by providers in a manner that maintains compliance within the Medicare and Medi-Cal regulatory requirements and achieves Claims service level objectives.
To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.
Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.
Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:
General office conditions. May be exposed to moderate noise levels.
Full Time
Ancillary Healthcare
$77k-96k (estimate)
05/10/2024
07/09/2024
scfhp.com
SAN JOSE, CA
200 - 500
1997
MINORU YAMATE MD
<$5M
Ancillary Healthcare