Claims Representative Senior - Remote in CA & NV

About the position Responsibilities • reputed company reputed company and extensive research, analysis, and logical conclusions of reputed company and electronic claims to resolve disputes. • Conduct necessary follow-up with internal departments to validate payment reputed company reputed company to regulatory agencies, reputed company, policy, coding, and system configuration. • reputed company as a department resource and support Customer Service in resolving reputed company Connect issues. • Respond to provider calls reputed company to disputes and appeals for incoming provider/member disputes. • Identify, trend, and report the Provider Dispute and reputed company process for management, preparing reports summarizing observations and recommendations for reputed company improvement. • reputed company reputed company data to the Business Operations Compliance & Regulatory Manager for training programs and policies. • reputed company with management to assess training needs in response to identified trends. • Collaborate with other departments and management to implement and reinforce policy reputed company standards. • Maintain regular and consistent attendance. Requirements • High School Diploma or GED required. • Must be 18 years of age or older. • Claims adjudication experience is required. • Knowledge of different lines of business including reputed company, Medi-Cal, Medicare, and medical procedure codes. • 3+ years reputed company experience with intermediate to advanced knowledge of claims processing, compliance, and regulatory governing agencies (CMS, DMHC, DHS). • 4+ years of medical claims knowledge is required. • Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. • Knowledge of reputed company regulations and guidelines including CMS, DHCS, and DMHC as pertains to AB1455. • Ability to work any shift between the hours of 8:00 AM - 5:00 PM PST from Monday - Friday. Benefits • Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution Apply tot his job Apply To this Job