What are the responsibilities and job description for the Claims Specialist Quality Assurance I position at Inland Empire Health Plan?
Overview
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 Claims Quality Assurance (QA) Manager and Supervisor, the Claims Specialist Quality Assurance I (CSQA) is responsible for ensuring the integrity of all data created and updated by the Claims Processing staff. The CSQA will utilize quality auditing tools, identify training needs, and define effective and efficient methods for accurate data entry and adjudication.
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.
Additional Benefits
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.
- Hybrid schedule.
- CalPERS retirement.
- 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
Key Responsibilities
Qualifications
Education & Requirements
- Two (2) years of experience in examining and processing institutional and professional claims
- High school diploma or GED required
Key Qualifications
- Medicare/Medi-Cal experience preferred
- Experience in a managed care environment helpful
- ICD-9/ ICD-10 and CPT coding and general practices of claims processing. Familiarity of Webstrat, Optum and CMS pricing
Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location
Telecommute
Pay Range
USD $25.90 - USD $33.02 /Hr.Salary : $26 - $33
