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Temporary Claims Specialist II - Provider Claims

LanceSoft, Inc.

Role overview

Qualifications

  • Four years of experience in a managed care environment in claims processing, appeals adjustments, and customer service
  • Thorough understanding of medical claim processing and customer service standards
  • Medi-Cal/Medicare experience preferred
  • High school diploma or GED required

Responsibilities

  • Review and process provider dispute resolutions according to state and federal designated timeframes
  • Draft written responses to providers in a professional manner within required timelines
  • Research reported issues; adjust claims and determine the root cause of the dispute
  • Maintain, track, and prioritize assigned caseload through IEHP’s provider dispute database

Key facts

Hard skills

Microcomputer Windows Software Data Entry Medicaid Medicare Organizational Structure

Other skills

  • Analytical Skills
  • Problem Solving
  • Customer Service
  • Microsoft Office
  • Microsoft Excel
  • Typing
  • Communication
  • Social Skills
  • Patience

About the company

LanceSoft, Inc. logo

LanceSoft, Inc.

Staffing & Recruiting

Established in 2000, LanceSoft is a pioneer in delivering top-notch Global Workforce Solutions and IT Services to a diverse clientele. As a Certified MBE and Woman-Owned organization, we pride ourselves on fostering global cross-cultural connections that advance both the careers of our employees and the success of our clients' businesses. At LanceSoft, our mission is clear: to leverage our global network to seamlessly connect businesses with the right talent and individuals with the right opportunities, all without bias. We believe in providing Global Workforce Solutions with a personalized, human touch. Our comprehensive range of services spans various domains, encompassing temporary and permanent staffing, Statement of Work (SOW) arrangements, payrolling, Recruitment Process Outsourcing (RPO), application design and development, program/project management, and engineering solutions. Currently, our team of over 5,000 professionals caters to 110+ enterprise clients worldwide, including Fortune companies. Our client base represents a diverse spectrum of industries, including Banking & Financial Services, Semiconductor/VLSI, Technology, Healthcare & Life Sciences, Government, Telecom & Media, Retail & Distribution, Oil & Gas, and Energy & Utilities. Headquartered in Herndon, VA, LanceSoft operates 32+ regional offices across the North America, Europe, Asia, and Australia. We also have nine delivery centers strategically located in India in Bangalore, Indore, Noida, Baroda, Hyderabad, Bhubaneshwar, Dehradun, Goa, and Aligarh to further enhance our client service capabilities.

Company details

Company typeXLarge
IndustryStaffing & Recruiting
Company size5001 - 10000

Links

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Job description

Title: Temporary Claims Specialist II - Provider Claims
Assignment Length: Six Months

WORK LOCATION: 10801 6th St STE 120, Rancho Cucamonga, CA 91730

Key Responsibilities:
  • Review and process provider dispute resolutions according to state and federal designated timeframes.
  • Review and assist with applying identified refunds submitted by the CART team.
  • Research reported issues; adjust claims and determine the root cause of the dispute.
  • Draft written responses to providers in a professional manner within required timelines.
  • Independently review and price complex edits related to all claim types to determine the appropriate handling for each including payment or denial.
  • Complete the required number of weekly reviews deemed appropriate for this position.
  • Respond to provider inquiries regarding disputes that have been submitted.
  • Maintain, track, and prioritize assigned caseload through IEHP’s provider dispute database to ensure timely completion.
  • Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed.
  • Communicate with a variety of people, both verbally and in writing, to perform research, gather information related to the case that is under review.
  • Recommend opportunities for improvement identified through the trending and analysis of all incoming PDRs.
  • Coordinate with other departments as necessary to facilitate resolution of claim related issues. Identify and report claim related billing issues to various departments for provider education
  • Any other duties as required to ensure Health Plan operations are successful.
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.

Qualifications
  • Education & Requirements
  • Four (4) years of experience in a managed care environment in the area of claims processing; appeals & adjustments, and customer service, preferably in an HMO or Managed Care setting
  • A thorough understanding of medical claim processing and customer service standards
  • Medi-Cal/Medicare experience and prior experience in a lead role preferred
  • High school diploma or GED required

Key Qualifications
  • Must have a valid California Driver's license
  • Understanding of claim appeal process, provider contracts, claim system functionality and medical claim processing practices
  • Strong analytical and problem-solving skills
  • Microsoft Office, Advanced Microsoft Excel
  • Microcomputer skills, proficiency in Windows applications preferred
  • Excellent oral and written communication skills
  • Excellent communication and interpersonal skills
  • Customer service skills and skilled in data entry required
  • Typing a minimum of 45 wpm
  • Ability to build successful relationships across the organization
  • Professional demeanor and strong organization skills
  • High degree of patience

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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