Claims Specialist

The Claim Specialist position is responsible for assisting the billing department with special projects that fall outside of an adjudicator function. He/she will serve as a liaison between coordination, adjudication, EOP, billing, collections and operations. He/she will have to learn all aspects of each department within billing and the call center. This position involves strong verbal and written communication, computer skills, problem solving and time management. This position will work in conjunction with the Leads from each department in billing. Essential Duties and Responsibilities: * Run a query in LogistiCAD for the Open Claims * Manage monthly OCR and report to CA Operations * Educate providers and act as liaison * Review possible MRU claims to determine if claim has to be sent the medical review unit of the insurance company * Refer claims to MRU; update spreadsheet: follow-up and provide quarterly reporting to operations * Review and potentially process NET rejections claims based on volume * Maintain the FaxPress file and route all faxes to appropriate files * Complete the month end close Medicare/Medi-Cal spreadsheet provided by Corporate * Run and resolve the received/not paid report * Act as a liaison between NET and CBL claims * Handle special projects as assigned * Act as a backup to the Lead as needed REQUIREMENTS Education/Certifications: * Qualified candidates will have a High School Diploma or General Education Degree * Medical/ambulance claims coding certificate recommendedExperience: * Previous experience in health care benefits or claims processing preferred * Prior training experience preferred * Minimum one year experience leading or directing staff preferredSkills: * Must be proficient in Microsoft Excel, Word, Access and Outlook * LogistiCAD and Delta Force experience preferred * Able to toggle between multiple systems successfully * Ability to learn propriety software application quickly * Proficient in internet search tool * Superior customer service and professional phone skills Competencies: * Analytical Skills - Ability to use thinking and reasoning to solve a problem * Communication, Oral - Ability to communicate effectively with others using the spoken word * Communication, Written - Ability to communicate in writing clearly and concisely * Customer Oriented - Ability to take care of the customers' needs while following company procedures. * Decision Making - Ability to make critical decisions while following company procedures. * Interpersonal - Ability to get along well with a variety of personalities and individuals. * Problem Solving -- Ability to find a solution for or to deal proactively with work-related problems * Relationship Building - Ability to effectively build relationships with customers and co-workers * Working Under Pressure - Ability to complete assigned tasks under stressful situationsEnvironmental and Working Conditions: * Entire work time is conducted in an office setting We are an equal opportunity employer. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled