Claims Customer Service Specialist
Job Number: 1210
Position Title: Claims Examiner
The Customer Service Specialist is responsible for answering incoming calls from providers while ensuring a high level of customer service. Requires the ability to multi-task while providing accurate and timely information.
Essential duties and responsibilities include but are not limited to:
- Responsible for resolving provider claim inquiries related to claim status, appeal status, and claim processing outcome.
- Utilize EZ CAP claim processing system and customer service skills to effectively communicate to provider telephone calls.
- Data entry of manual claims into EZ CAP claims system
- Utilize claim knowledge, judgment, and problem solving skills to ensure accurate message to providers via use of standard claim processing documents (Standard Operating Procedures, Policy and Procedures, DOFR, contract etc.).
- Ability to positively meet the needs of providers through professional communication that demonstrates the company culture
- Participate in Claims Department team meetings and other activities as needed.
- Ensure the privacy and security of PHI(Protected Health Information) as outlined in department policies and procedures relating to HIPAA Compliance
- Other duties and projects as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- 1 year of customer service experience analyzing and solving provider problems
- High School Diploma or GED
- Claim processing experience
- Medicare Claim knowledge
- EZ CAP experience preferred
- Ability to multi-task
- Ability to remain focused and productive each day through task.
- Knowledge of Division of Financial Responsibility(DOFR)
Skills and Abilities
- Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
- Mathematical Skills: Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
- Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
- Computer Skills: Knowledge of computer programs and applications required.
- Other Skills and Abilities:
- Team player.
- Multi-tasking capabilities.
- Good written and verbal communication skills required.
- Ability to operate a telephone, computer, copier, fax machine, and other office equipment.
- Ability to travel between locations is essential.
The physical demands 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.
- While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
- The employee is frequently required to reach with hands and arms.
- The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl.
- The employee must occasionally lift and/or move up to 25 pounds.
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The noise level in the work environment is usually moderate.
Location City: Orange
Location State: California
Community / Marketing Title: Claims Customer Service Specialist
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
EEO Employer Verbiage:
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact email@example.com.