New

Claims Resolution Specialist /Customer Service Specialist

22nd Century Technologies, Inc.
Payrate :$25.87 - 38.81/hr. w2
United States, California, Orange
Feb 26, 2026
Job Title: Claims Resolution Specialist /Customer Service Specialist Duration: 6 months Location: Orange, CA 92868 Fully Onsite Payrate :$25.87 to 38.81/hr. on w2 without benefits Shift: Mon - Fri \| 8:00 a.m. to 5:00 p.m. Role & Responsibilities: 80% - Claims Support Responds to provider questions and researches issues regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures. Follows up with providers as needed. 15% - Administrative Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Ensures accurate and timely documentation regarding all issues, and/or inquiries are entered in Facets. Routes escalated calls to the appropriate departments and/or management. 5% - Other Completes other duties or projects as assigned. Minimum Qualifications: High school diploma or equivalent PLUS 2 years of experience in claims resolution required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 1 year of call center experience with high call volumes or customer service experience required. 1 year of HMO, Medi-Cal/Medicaid and healthcare/managed care experience required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.