What are the responsibilities and job description for the Lead Claims Processor 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 Manager and Supervisor, the Lead Claims Processor is responsible for fulfilling the technical support needs of claims processing staff and handling complex claims. This includes but is not limited to; high dollar, dialysis, oncology / chemo, hospital exclusions and claim adjustments in an accurate and expedient manner. Additional duties include assistance with claim inventory control and regulatory audit needs. The Lead Claims Processor has direct communication with other internal and external business units in an effort to resolve claim issues or obtain process clarification.

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; we also aim to match our Team Members with the same energy by providing prime benefits and more.

CalPERS retirement
457(b) option with a contribution match
Generous paid time off- vacation, holidays, sick
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Paid life insurance for employees with additional options
Short-term, and long-term disability options
Pet care insurance
Flexible Spending Account - Health Care / Childcare
Wellness programs that promote a healthy work-life balance
Career advancement opportunities and professional development
Competitive salary with annual merit increase
Team bonus opportunities

Key Responsibilities

Support claim processing staff with technical questions and business rule clarification.

Assist Supervisor with inventory control and compliance monitoring.

Coordinate workflow needs relating to regulatory audits.

Assist with developing and mentoring of new team members.

Assist with the testing of new claim processing procedures.

Assist with the development and update of policies and procedures for the claims department.

Conduct refresher training of claims staff based on identified error trends.

Adjudicate complex professional and institutional claims.

Responsible for meeting modified performance measurement standards for productivity and accuracy.

Interface with other IEHP business units, vendors, and providers as needed.

Assist other business units as directed by Claims Supervisor

Adjudication of claim adjustments as assigned.

Participate in Claims Department Team Meetings, and other activities as needed.

This position provides support to all unit Team Members.

Qualifications

Education & Experience

Minimum of four (4) years of experience in adjudicating inpatient and outpatient professional and institutional medical claims

Experience preferably in an HMO or Managed Care setting

Medicare and / or Medi-Cal experience preferred

Prior experience in a lead role or customer service environment is a plus

High School Diploma or GED required

Key Qualifications

Must have a valid California Driver's license

Advanced knowledge of medical claim processing requirements

Microcomputer skills, proficiency in Windows applications preferred. Excellent communication and interpersonal skills. Strong organizational skills required

Professional demeanor

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location

Telecommute

Pay Range

USD $27.43 - USD $35.66 / Hr.

Salary : $27 - $36

Apply for this job

Receive alerts for other Lead Claims Processor job openings

Job openings at Inland Empire Health Plan

Behavioral Health Care Manager, Licensed (Hybrid Work Schedule)

Inland Empire Health Plan

Rancho Cucamonga, CA Full Time

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring ...

Engineer III - Middleware

Inland Empire Health Plan

Rancho Cucamonga, CA Full Time

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring ...

Inland Empire Health Plan is hiring: Manager, UI Development in Rancho Cucamonga

Inland Empire Health Plan

Rancho Cucamonga, CA Full Time

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring ...

Director, Technology - Solutions Delivery

Inland Empire Health Plan

Rancho Cucamonga, CA Full Time

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring ...

Not the job you're looking for? Here are some other Lead Claims Processor jobs in the San Francisco, CA area that may be a better fit.

Claims Processor

George Hills Company, San Francisco, CA

Claims Processor 1

Zenith American Solutions, San Francisco, CA

Lead Claims Processor

What are the responsibilities and job description for the Lead Claims Processor position at Inland Empire Health Plan?

What is the career path for a Lead Claims Processor?

Job openings at Inland Empire Health Plan

Not the job you're looking for? Here are some other Lead Claims Processor jobs in the San Francisco, CA area that may be a better fit.

We don't have any other Lead Claims Processor jobs in the San Francisco, CA area right now.

AI Assistant is available now!