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Providence Associate Claims Specialist (Remote: Portland, OR) in Vancouver, Washington


Providence is calling an Associate Claims Specialist who will:

  • Process claims for members, providers, and employers

  • Provide and interpret detailed benefit, eligibility, and premium information on a broad portfolio of products

  • Respond to claim inquires, and resolve member issues or concerns

  • Correctly analyze and adjudicate claims to reflect financial, check, and processing accuracy.

We welcome 100% remote work for residents living within a fifty to sixty mile radius of Portland, OR.

In this position you will:

  • Processes all claims entry level to intermediate in all categories in a minimum of one product, as defined by Providence Health Plans

  • Processes pends and error codes. Research and resolve pended claims

  • Works team reports: 28 day delay report, overpayment reports, retro referral report, retro authorization report, split reports, missing image reports, PPO/no EPO report, daily aging reports, PHS reports, and co-payment reports

  • Handles incoming mail, provider appeals, inquires, and tracers. Review member correspondence and process or direct to the appropriate department

Additional Responsibilities:

  • Claims processors will work beginning to intermediate CSI's. Investigates and responds to department customer service inquiries (CSI) within company standards

  • Interpret benefits, payment rules/exceptions, plan documents, literature, and general delivery system requirements

  • Identify and research coordination of benefits issues and send to appropriate department

  • Assist in identifying data base errors in Facets, Worksight and custom data bases

  • Research, investigate and resolve members, providers, and employers issues of concern and dissatisfaction

  • Collaborates with Quality Medical Management and other teams/departments as appropriate to address and resolve customer concerns or complaints, and to follow up on requests for information

  • Identifies and remedy's inappropriate billing practices and other practice patterns based on ground rules established by the rules and regulations of CPT/ICD-9/ICD-10 coding and Health Plan payment rules

  • Provide member, provider, and employer education to all contacts as appropriate

Required qualifications for this position include:

  • 2 years' experience with claims, customer service or accounting

Preferred qualifications for this position include:

  • Bachelor's Degree

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.

We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

Requsition ID: 137643
Company: Providence Jobs
Job Category: Claims
Job Function: Revenue Cycle
Job Schedule: Full time
Job Shift: Day
Career Track: Admin Support
Address: OR Beaverton 3601 SW Murray Blvd

Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.