Associate Claims Specialist (Remote)

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Posted 6 days ago United States Salary undisclosed
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Job Description

Providence is calling an Associate Claims Specialist who will: Process claims for members, providers, and employers Provide and interpret detailed benefit, eligibility, and premium information on a broad portfolio of products Respond to claim inquires, and resolve member issues or concerns Correctly analyze and adjudicate claims to reflect financial, check, and processing accuracy. We welcome 100% remote work for residents living in the cities of Portland, OR and Vancouver, WA. In this position you will: Processes all claims entry level to intermediate in all categories in a minimum of one product, as defined by Providence Health Plans Processes pends and error codes. Research and resolve pended claims Works team reports: 28 day delay report, overpayment reports, retro referral report, retro authorization report, split reports, missing image reports, PPO/no EPO report, daily aging reports, PHS reports, and co-payment reports Handles incoming mail, provider appeals, inquires, and tracers. Review member correspondence and process or direct to the appropriate department Additional Responsibilities: Claims processors will work beginning to intermediate CSI's. Investigates and responds to department customer service inquiries (CSI) within company standards Interpret benefits, payment rules/exceptions, plan documents, literature, and general delivery system requirements Identify and research coordination of benefits issues and send to appropriate department Assist in identifying data base errors in Facets, Worksight and custom data bases Research, investigate and resolve members, providers, and employers issues of concern and dissatisfaction Collaborates with Quality Medical Management and other teams/departments as appropriate to address and resolve customer concerns or complaints, and to follow up on requests for information Identifies and remedy's inappropriate billing practices and other practice patterns based on ground rules established by the rules and regulations of CPT/ICD-9/ICD-10 coding and Health Plan payment rules Provide member, provider, and employer education to all contacts as appropriate Required qualifications for this position include: 2 years' experience with claims, customer service or accounting Preferred qualifications for this position include: Bachelor's Degree Salary Range by Location: Washington (Puget Sound, Vancouver), Oregon (Portland) Min: $17.38 Max: $27.08 Oregon (Salem, Hood River, Medford, Seaside) Min: $16.20 Max: $25.25 Eastern Washington (Richland, Spokane, Walla Walla) Min: $15.47 Max: $ 24.10 Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.