New

Claims Specialist

TEKsystems
$18.00 - $25.00 / hr
United States, California, Fresno
Nov 23, 2024
Description: 1. Quotes benefits to members, IPA/HMO providers and non-IPA providers. 2. Verifies member eligibility. 3. Resolves member/provider claim issues. 4. Resolves issues with HMO provider/subscriber representatives. 5. Logs member ER visits in the UR computer file. 6. Fields, researches and analyzes member-generated inquiries. 7. Communicates, as needed, including verbal and written to representatives and supervisor. 8. Develops comprehensive knowledge of department activities, handles inquiries and provides response as it relates to area of responsibility for both departments. 9. Provides qualified, responsible and professional assistance that will demonstrate Sante Health System to be a company of quality service for the community. 10. Maintains confidentiality of sensitive information. 11. Provides continual and ongoing assessment and improvement of work processes. 12. Constantly strives to anticipate and exceed customer expectations. 13. In the spirit of teamwork, employees are expected to follow any other job-related instructions and to perform any other job-related duties as requested. Additional Skills & Qualifications: High School Diploma/GED equivalent required. Knowledge of insurance industry. Skill in operating a computer and photocopy machine. Ability to speak clearly and concisely. Ability to establish and maintain effective working relationships with members, physicians, co-workers and supervisors. Experience Level: Intermediate Level About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.