Senior Claims Specialist - USFHP

Adjudicates all claims submitted by outside purchased services for PMC's enrolled capitated population and communicates those actions. Adjusts complex claims for advanced processing needs. Responds to Customer Service Requests and resolves problem claim situations. Assists in managing the workflow of assigned Line of Business. Acts as primary department resource for at least one major area of expertise (EDI, Health Plan Repricing, Health Plus Repricing, or HPR). Required Qualifications Bachelor's Degree In related field or Equivalent experience in Health Care Business Administration. 4 years of Managed Care operations, including a minimum of 3 years claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting. Information systems supporting the administration of managed care products. IDX healthcare software application. CHAMPUS, Medicare and/or Medicaid benefits/programs. All areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health, Home Infusion, Kidney Dialysis Centers, Encounters). CRT. Preferred Qualifications Microsoft Windows, Word, Excel, and Mail. Benefits Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. #J-18808-Ljbffr Providence Health & Service