What are the responsibilities and job description for the Senior Claims Specialist - USFHP position at PROVIDENCE ST JOHNS HEALTH CENTER?
Description
ReqID: 346340
Job Category: Claims
Shift: Day
Schedule: Full time
Must be an accomplished claims adjudicator with at least 3 years prior claims processing experience. This role is a senior level position and will have responsibility for the advanced processing, auditing, and reporting on claims production and quality. This role will assist in responding to Customer Service requests and the resolution of problem claims situations. Assists the Claims Supervisor in managing workflows to ensure the highest level of quality and accuracy for USFHP claims processing.
The successful candidate in this role will be a proactive, effective communicator who is passionate about quality, training, and helping others achieve. Must be skilled at working cross functionally, and at all levels of the organization to ensure best practice and adherence to standards at USFHP at all times. Must be proficient/advance in Excel skills -comfortable using large amounts of data, pivot table, creating reports, and communicating results to leaders across the business.
Providence caregivers are not simply valued – they’re invaluable. Join our team at PacMed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our mission to advocate, educate and provide.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
About The Team
Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting-edge technology, first-class facilities and board-certified providers.
Our strong team environment and respect for our people—at all levels and from all backgrounds—allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
Pay Range: $ 22.62 - $ 35.22
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Please be advised that our application system will be unavailable from Jan. 17 at 7 p.m. PT until approximately 1 a.m. PT on Jan. 18 as we implement enhancements.
Apply Now Caregivers/ Employees Apply Here
ReqID: 346340
Job Category: Claims
Shift: Day
Schedule: Full time
Must be an accomplished claims adjudicator with at least 3 years prior claims processing experience. This role is a senior level position and will have responsibility for the advanced processing, auditing, and reporting on claims production and quality. This role will assist in responding to Customer Service requests and the resolution of problem claims situations. Assists the Claims Supervisor in managing workflows to ensure the highest level of quality and accuracy for USFHP claims processing.
The successful candidate in this role will be a proactive, effective communicator who is passionate about quality, training, and helping others achieve. Must be skilled at working cross functionally, and at all levels of the organization to ensure best practice and adherence to standards at USFHP at all times. Must be proficient/advance in Excel skills -comfortable using large amounts of data, pivot table, creating reports, and communicating results to leaders across the business.
Providence caregivers are not simply valued – they’re invaluable. Join our team at PacMed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications
- Bachelor's Degree In related field. Or Equivalent experience in Health Care Business Administration.
- 4 years Managed Care operations, including a minimum of 3 years claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.
- Information systems supporting the administration of managed care products.
- IDX healthcare software application.
- CHAMPUS, Medicare and/or Medicaid benefits/programs.
- All areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health, Home Infusion, Kidney Dialysis Centers, Encounters).
- CRT.
- Microsoft Windows, Word, Excel, and Mail.
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our mission to advocate, educate and provide.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
About The Team
Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting-edge technology, first-class facilities and board-certified providers.
Our strong team environment and respect for our people—at all levels and from all backgrounds—allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
Pay Range: $ 22.62 - $ 35.22
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Please be advised that our application system will be unavailable from Jan. 17 at 7 p.m. PT until approximately 1 a.m. PT on Jan. 18 as we implement enhancements.
Apply Now Caregivers/ Employees Apply Here
Salary : $23 - $35
