Claims Customer Service Representative

We have an opportunity to join the Alliance as Claims Customer Service Representative.

*This position is open to current Alliance employees and current Temporary employees on assignment at the Alliance.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Claims Manager, this position:

• Acts as a frontline customer service representative and researches, resolves, and responds to inquiries regarding claims issues from providers and Alliance staff
• Processes various claim types and conducts research and analysis related to claims resolution
• Maintains current knowledge of claims processes, procedures, and related documentation, assists in developing and maintaining internal operating procedures, and recommends coding and reimbursement changes in the Alliance’s claims processing system

ABOUT THE TEAM

​​We handle billing-related inquiries and issues from providers concerning treatment, services and care of our members.:

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

• Knowledge of:
  • Methods and techniques of medical claims processing
  • General administrative procedures and standard business office practices and equipment
  • Principles and practices of customer service
  • Reading medical insurance Explanation of Benefits
• Ability to:
  • Effectively and clearly document, summarize and resolve concerns and inquiries related to claims issues and recognize those issues requiring escalation to a higher-level staff member
  • Gather and evaluate information, ask appropriate questions, and utilize problem solving skills · 
  • Utilize a variety of computer systems, including the Alliance information system and external websites and databases
  • Understand and communicate the complex operations and processes of the Alliance, particularly the Utilization Management, Care Management, and Member Services departments
• Education and Experience:
  • High School Diploma or equivalent and a minimum of two years of experience performing claims processing in a Medi-Cal or managed care environment (an Associate’s degree may substitute for one year of the required experience); or an equivalent combination of education and experience may be qualifying

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below. 

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area

OUR BENEFITS 

Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

• Medical, Dental and Vision Plans
• Ample Paid Time Off 
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. 

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.