Healthcare Claims Specialist (Call Center) in Burbank, CA at Volt

Date Posted: 11/6/2019

Job Snapshot

  • Employee Type:
    Direct Hire
  • Location:
    Burbank, CA
  • Job Type:
  • Duration:
    N/A
  • Date Posted:
    11/6/2019
  • Job ID:
    205245
  • Contact Name
    Volt Branch
  • Phone
    805-560-8658 x21305

Job Description

A very reputable company in the Burbank area is hiring for a Healthcare Claims Specialist with at least 4 years of Claims Processing experience. This is a permanent position opportunity with great healthcare benefits and a Pension. 

Please send your resume to icarroll@volt.com

This Claims Specialist will provide direction to claims staff regarding claims processing policies and procedures.  Review, analyze, investigate, and make liability decisions and approvals for the release of benefit payment on utilization management files. Examine and process health insurance claims and service calls from physicians, hospitals and customers, as required.  Adhere to claim and call policies and procedures while making accurate claim/call decisions.  

PRIMARY RESPONSIBILITIES:

  • Review the Anthem Blue Cross utilization management authorization spreadsheet and setup authorizations in the system
  • Review claims pended by the system and/or claim adjuster that require utilization management authorizations, and then set-up authorizations in the system as required 
  • Communicate utilization management decisions in writing to all applicable customers, as well as make necessary calls, when applicable 
  • Review and process Medicare Secondary Payer (MSP) and MEDICAID-DHCS claims
  • Flag system for W-9 forms and update the record when received
  • Execute Coordination of Benefit (COB) system updates
  • Index and audit claim batches and other miscellaneous documents
  • Process claims and conduct follow-up on all pending claim items
  • Manage subrogation / third party liability / workers compensation files
  • Handle subpoena requests
  • Manage 1099 report processing
  • Handle medical files received from medical consultant
  • Assist with the development of claim policy and procedures and workflows.
  • Track and trend appeals, litigation's, Department of Labor (DOL) and subpoena files for staff development or Participant education
  • Accurately answer and service incoming phone calls from customers (i.e. benefit and eligibility, billing and payment inquiries, authorizations for treatment and explanation of benefits [EOBs])

KNOWLEDGE, SKILLS, ABILITIES:

  • Ability to accurately and efficiently process claims and provide complete information by using the right methods/tools
  • Excellent customer service and telephone skills
  • Excellent verbal and written communication skills
  • Ability to make decisions with every call and handle escalated issues
  • Knowledge of medical terminology
  • Ability to research and verify claims payment issues

REQUIREMENTS:

  • AA or BA degree preferred in related field
  • Minimum of four (4) years of claim processing and healthcare call center environment experience
  • Strong knowledge of benefit plans, policies and procedures
  • Strong phone contact handling and active listening skills
  • Proficient with Microsoft products, including Word and Excel

VOLT is an Equal Opportunity Employer 

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