Claims Specialist - Covered California

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the direction of the Covered California Claims (CCA) Manager, the CCA Claims Specialist is responsible for analyzing, managing, and investigating complex and high-dollar healthcare claims that require in-depth research to determine accuracy and mitigate payment errors. The Claims Specialist is also responsible for adjusting first-pass and post-pay claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. This position collaborates with internal stakeholders, assists with claim audits (internal and regulatory) and utilizes strong analytical skills and independent judgement skills to make effective and accurate decisions. This position will also be responsible for responding to inquiries from the Provider Payment Resolution team on claims that may have been paid incorrectly.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary
Telecommute schedule
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Education & Requirements

Three (3) years of experience in examining and processing complex and high-dollar institutional and professional claims
Experience in a managed care environment helpful. Commercial, Exchange, and Medicare preferred
High school diploma or GED required
Associate’s degree from an accredited institution preferred

Key Qualifications

ICD-9/ ICD-10 and CPT coding and general practices of claims processing
CMS/DMHC and Affordable Care Act regulations and guidelines
Commercial line of business specifically Covered California/Exchange
Excellent communication and interpersonal skills
Excellent analytical, critical thinking, customer service, and organizational skills
Ability to think critically with the capacity to work independently
All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership

Start your journey towards a thriving future with IEHP and apply TODAY!

Pay Range

$25.90 USD Hourly - $33.02 USD Hourly