Claims Technician I

Location: Scotts Valley, California

We have an opportunity to join the Alliance as a Claims Technician I in the Claims Operations Department.

This is a full time in office position.

Reporting to the Claims Supervisor, this position:

• Opens, sorts, prepares, batches, and scans claim forms and other documents
• Performs data entry and verifies, validates, and processes claims
• Assists with training of new hires in the claims control function and with cross-training other Claims Technicians I
• Provides support to Provider Disputes staff

ABOUT THE TEAM

Our teams work closely together to support Alliance members' access to care by ensuring medical services are paid to network providers accurately and on time.

THE IDEAL CANDIDATE

• Experience performing medical claims processing or medical billing
• Some knowledge of medical terminology and related procedure and diagnostic coding, such as Current Procedural Terminology (CPT), International Classification of Diseases (ICD), and Healthcare Common Procedure Coding System (HCPCS), including knowledge of how to access available resource tools
• Some knowledge of the Medi-Cal program and related regulations

WHAT YOU'LL NEED TO BE SUCCESSFUL

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

• Knowledge of:




• The principles and practices of customer service
• General administrative procedures, standard business office practices and the operation of general office equipment, such as computer, telephone, copier, scanner and fax




• Ability to:
  
  
  
  • Keep current with claims processing practices and procedures
  • Read and understand medical insurance Explanation of Benefits
  • Interpret, apply, and explain processes, policies, and procedures
  • Document, summarize and resolve routine issues and recognize those issues requiring escalation to a higher-level staff member
  
  
  
  
• Education and Experience:
  
  
  
  • High School Diploma or equivalent and a minimum or one year of administrative 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