Health Claims Specialist - Military Veterans

AppleOne is proud to present:
A progressive third party administrator of health and welfare benefits is looking to hire a bi-lingual English/Spanish Health Claims Specialist. This position plays a vital role by processing and managing insurance claims, ensuring that the claims are accurate, complete, and processed in a timely manner. They serve as intermediaries between healthcare providers, insurance companies, and members, ensuring that claims are filed properly and meet necessary regulatory requirements.
Job Summary:
A Health Claims Specialist is responsible for reviewing, processing, and managing healthcare claims to ensure accuracy, compliance, and timely payment. The role requires strong knowledge of insurance policies, medical terminology, and billing procedures.
Key Responsibilities:

• Claims Processing: Review and process insurance claims for medical procedures, treatments, and services provided. Ensure that claims are accurate and comply with insurance policies.
• Claim Verification: Verify insurance coverage and eligibility for members, ensuring that all necessary documentation is provided.
• Communication: Communicate with healthcare providers, insurance companies, and members to resolve discrepancies, clarify billing issues, and address any concerns.
• Data Entry: Accurately input member, provider, and insurance information into the claims processing system.
• Regulatory Compliance: Ensure that all claims adhere to industry regulations, such as HIPAA (Health Insurance Portability and Accountability Act), and comply with the standards set by insurance providers.
• Problem Resolution: Investigate and resolve any issues with denied or delayed claims, including identifying errors, coordinating with the appropriate parties, and resubmitting claims when necessary.
• Record Maintenance: Maintain accurate and detailed records of all claims, adjustments, and payments.
• Customer Service: Provide customer service to members, healthcare providers, and insurance representatives regarding claim status and resolution.
• Reporting: Prepare reports on claims processing performance, including denial rates, turnaround times, and payment issues.

Skills and Qualifications:

• Education: High school diploma or equivalent is required; an associate's degree or certification in health information management, medical billing, or a related field is preferred.
• Language: English and Spanish fluency a must
• Experience: Previous experience in medical billing, coding, or insurance claims processing is highly preferred.
• Technical Skills: Proficiency with medical coding software, claims management systems, and Microsoft Office Suite.
• Knowledge of Insurance: Familiarity with medical insurance policies, claim adjudication processes, and regulations.
• Attention to Detail: Ability to accurately process claims, identify errors, and ensure compliance with medical billing standards.
• Communication Skills: Excellent written and verbal communication skills to interact effectively with patients, providers, and insurance companies.
• Problem-Solving: Strong analytical skills to troubleshoot issues and ensure claims are processed correctly.
• Organizational Skills: Ability to manage multiple claims simultaneously while maintaining a high level of accuracy and efficiency.

For immediate consideration, apply today!


EEO/AA Employer/Vet/Disabled.





The Know Your Rights poster is available here:


https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf





The pay transparency policy is available here:


https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf





For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.





We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.





AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.


https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf





We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.


#1038

Experienced (Non-Manager)