Claims Specialist – Quality Assurance I

This is a fully remote position, open to applicants in California.

📋 Description

• Maintain the accuracy of all data generated and modified by the Claims Processing team.

• Employ quality auditing tools effectively.

• Assess training requirements.

• Establish efficient and effective methods for precise data entry and adjudication.

• Integrate IEHP’s Quality Program objectives, which include HEDIS, CAHPS, and NCQA Accreditation.

• Operate under the guidance of the Claims Quality Assurance Manager and Supervisor.

⛳️ Requirements

• A minimum of two (2) years of experience in reviewing and processing institutional and professional claims.

• Preferred experience with Medicare/Medi-Cal.

• Background in a managed care setting is advantageous.

• High school diploma or GED is mandatory.

• Knowledge of ICD-9/ICD-10 and CPT coding along with general claims processing practices.

• Familiarity with Webstrat, Optum, and CMS pricing is necessary.

• Exceptional communication and interpersonal abilities.

• Strong organizational skills are required.

• Proficient microcomputer skills.

• Preferred expertise in Windows applications.

• Professional demeanor is essential.

🏝️ Benefits

• Competitive salary.

• On-site state-of-the-art fitness center.

• Medical Insurance, including Dental and Vision coverage.

• Options for life, short-term, and long-term disability insurance.

• Opportunities for career advancement and professional development.

• Wellness programs that foster a healthy work-life balance.

• Flexible Spending Account options for Health Care and Childcare.

• CalPERS retirement plan.

• 457(b) plan with a contribution match.

• Paid life insurance for employees.

• Pet care insurance.