Claim Representative - Claims

Company: St. Joseph Health
Location: Anaheim
Posted on: June 16, 2022

Job Description:

Claim Representative - Claims

Location: Anaheim, CA

Work Schedule: Full Time - 80 Biweekly Hours

Shift: 8-hour, Days

Working under the direction of the Director, this position is responsible for consistently and accurately adjudicating all contracted professional capitated claims with fee- for-service carve outs and, contracted fee-for-service claims for both Commercial and Senior plans within the timeliness and accuracy standards set forth by CMS, Department of Managed Care, AB1455 and the Claims Department polices and procedures.

Required qualifications:

* 2 years experience as a Claims Examiner in an IPA, Medical Group or Health Plan.



Preferred qualifications:

* Experience within the Health Care Industry.


* IDX experience.



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 of caring for everyone, especially the most vulnerable in our communities.

Providence Medical Foundation (formerly St. Joseph Heritage Health) includes seven medical groups throughout Northern California, Orange County, High Desert and Los Angeles County. With 175 locations and nearly 4,000 caregivers (employees), Providence Medical Foundation has been continually recognized as a leader in quality, receiving top honors from various organizations, including the Orange County Medical Association for Physicians of Excellence and the Integrated Healthcare Association with distinction in clinical quality. Providence Medical Foundation provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Providence Medical Foundation complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Keywords: St. Joseph Health, Anaheim , Claim Representative - Claims, Other , Anaheim, California