Job title: Senior Claims Specialist
Company: Personify Health
Job description: Overview:Now is the time to join us!We’re Personify Health. We’re the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future. Responsibilities:Who are you?The Senior Claims Specialist will provide exceptional customer service as an onsite liaison, reviewing, evaluating, and authorizing payments for claims under various group health plans. Responsibilities include tracking and reporting potential Workers Comp claims to the carrier. As a Senior Claims Specialist, you must accurately adjudicate claims and respond to inquiries in accordance with organizational policies. This role involves interacting with providers, carriers, plan participants, dependents, retirees, and client contacts.In this role you will wear many hats, but your knowledge will be essential in the following:
- Work under the guidance and direction of the Claims Supervisor.
- Research disputed benefit coverage issues as identified in Health Plan Benefit Documentation
- Respond to inquiries from callers, walk-ins or correspondence regarding health plans, policies, and procedures.
- Utilize reference material and fee schedules to obtain accurate information.
- Contacting sources within or outside the organization to obtain information.
- Identifying health plan coding that may be related to Workers Compensation claims.
- Coordinating medical records and other transcription necessary to determine injury liability.
- Identifying and determining action to be taken in order to resolve a variety of problems.
- Coordinating with and educating health plan members on benefits & coverage related to Workers Compensation.
- Coordinate with third party clinics, workers comp administrators and insurance coverage partners.
- Prepare or initiate a variety of correspondence and documents to respond to inquiries or to adjust records.
- Prepare routine reports and document all phone inquiries in patient notes.
- Research claims in order to apply the proper limitations and provisions of each plan.
- Read, interpret, understand and apply contract benefits, limitations and provisions.
- Understand and apply insurance laws and regulations.
- Refer to various manuals, fee schedules and reference materials to obtain accurate information.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Qualifications:What you bring to the Personify Health team:In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:
- High School Diploma or GED
- Prior experience in a healthcare related field required
- Strong background in customer service, with a focus on delivering excellent support and assistance
- 2 plus years’ experience with medical claims processing experience preferred
- Workers compensation claims experience preferred
- Experience in self-funded plan administrations a plus
- Must be within driving distance of Los Angeles, California, and willing to work on-site three days a week in an office environment
You also take pride in offering the following Core Skills, Competencies, and Characteristics:
- Excellent written and verbal communications skills
- Professional telephone presence including excellent listening skills
- Knowledge of medical terminology, CPT, HCPCS and ICD-10 required
- Strong computer skills including familiarity with Microsoft Office tools
- Analytical and problem-solving skills necessary to identify and review pertinent information
- Ability to maintain a very high level of confidentiality
- Able to successfully handle competing priorities
- Proactive team member with attention to detail and follow through
Work schedule: This is a hybrid role based in Los Angeles, California, requiring on-site work Tuesday, Wednesday, and Thursday from 8:00 AM to 4:30 PM PST. Remote work is expected on Monday from 8:00 AM to 4:30 PM PST and Friday from 7:00 AM to 3:30 PM PST.No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $21.00 to $27.00. Note that compensation may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.#WeAreHiring #PersonifyHealth #HybridBeware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to . All of our legitimate openings can be found on the Personify Health .Application Deadline: Open until position is filled.
Expected salary:
Location: Los Angeles, CA
Job date: Thu, 10 Apr 2025 00:53:32 GMT
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