an accurate and expedient manner. Major Functions (Duties and Responsibilities) 1. Adjudicates complex professional and institutional claims. 2. Assist with training and mentoring of new team members. 3. Assist with the testing of new claim processing procedures or projects.
4. Responsible for meeting performance measurement standards for productivity and accuracy. 5. Adjudication of claim adjustments. 6. Review and correct claims involving data integrity issues. 7. Interface with other IEHP Departments, when necessary, regarding claims issues. 8. Participate in Claims Department Team Meetings, and other activities as needed. Major Functions (Duties and Responsibilities) Cont Supervisory
Responsibilities Leading: Self Experience Qualifications Three (3) years experience in adjudicating medical claims. Preferred Experience Experience in adjudicating medical claims: professional and institutional preferably in and HMO or Managed Care setting.
Medicare/Medi-Cal experience preferred. Education Qualifications High School Diploma or GED required. Preferred Education Professional Certification Professional Licenses Drivers License Required No Knowledge Requirement ICD-9 and CPT coding and general practices of claims processing. Skills Requirement Microcomputer skills, proficiency in Windows applications preferred. Eexcellent communication and interpersonal skills, strong organizational
skills required. Abilities Requirement Professional demeanor.
Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions Data entry involving computer keyboard and screens, filing and copying of records and/or correspondence. Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval.
All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership. Work Model Location Telecommute Physical Requirements Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Regular and reliable attendance - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular contacts: co-workers, supervisor - FREQUENTLY Keyboarding: 10-Key - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding: Traditional - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY Lighting - CONSTANTLY Near Visual Acuity - FREQUENTLY A reasonable salary expectation is between $48,110.40 and $59,425.60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work. ” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members.
And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
and adjudication. 2. Adjudicate all professional and outpatient facility claims including COB, denials, and reduction in service notifications 3. Interface with other IEHP Departments, when necessary, regarding claims issues. 4. Participate in Claims Department staff meetings, and other activities as needed 5.
Responsible for meeting the performance measurement standards for productivity and accuracy for one specific type of claim form, professional (HCFA) or institutional (UB. ) Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leading: Self Experience Qualifications Two (2) years experience in examining and processing medical claims; professional or institutional.
Preferred Experience Medicare/Medi-Cal experience preferred. Claim adjustments, provider appeals and/or disputes preferred. Education Qualifications High school diploma or GED required.
Preferred Education Professional Certification Professional Licenses Drivers License Required No Knowledge Requirement ICD-9 and CPT coding and general practices of claims processing. Prefer knowledge of capitated managed care environment. Skills Requirement Microcomputer skills, proficiency in Windows applications preferred. Excellent communication and interpersonal skills, strong organizational skills. Abilities Requirement Professional demeanor. Commitment to Team Culture The IEHP Team environment requires
a Team Member to participate in the IEHP Team Culture.
A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions Data entry involving computer keyboard and screens, filing, and copying of records and/or correspondence. Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
Work Model Location Telecommute Physical Requirements Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Regular contacts: co-workers, supervisor - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY Keyboarding: 10-Key - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding: Traditional - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY Lighting - CONSTANTLY A reasonable salary expectation is between $45,884.80 and $55,993.60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work. ” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
Manufacturing/Operation jobs involve the process of creating products from raw materials or components, typically in a systematic and organized manner. These roles often include tasks such as assembly, machine operation, quality control, and maintenance of equipment. Key features of these positions include hands-on work, adherence to safety protocols, a focus on efficiency and productivity, and the necessity of technical knowledge or specialized skills. Jobs in this sector can range from assembly line workers to machine operators and engineers, all contributing to the transformation of inputs into finished goods.
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Education Jobs refer to career opportunities within the educational sector, ranging from teaching and administration to curriculum development and educational policy-making. These positions are characterized by their focus on promoting learning, fostering student development, and contributing to the academic community. Educators are dedicated to shaping minds, imparting knowledge, and preparing the next generation for future challenges. Working in education typically requires a combination of specialized knowledge, patience, and a passion for teaching and mentorship.
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Quality Assurance (QA) jobs involve ensuring that products, services, or processes meet established standards of quality through systematic activities and measures. These roles typically focus on preventing defects, identifying potential issues, and implementing solutions to maintain quality consistency. Key features of QA positions include rigorous testing, meticulous attention to detail, and a commitment to continuous improvement. QA professionals work across various industries, from software development to manufacturing, to safeguard customer satisfaction and comply with regulatory requirements.
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Customer service jobs involve roles where individuals assist customers by providing information, answering questions, and resolving problems related to products or services. A key feature of these jobs is the focus on enhancing customer satisfaction and fostering positive relationships. Occupants of these positions often need strong communication skills, patience, and problem-solving abilities. They can be found in various sectors like retail, finance, hospitality, and tech. Customer service jobs may include in-person roles, such as a store clerk, or remote positions, like a call center agent. Flexibility and adaptability are also important, as customer service representatives must handle diverse inquiries and sometimes deal with challenging situations.
Education jobs encompass a variety of roles within the educational sector, designed to both impart knowledge and foster development from early childhood education through higher education and adult learning. These positions include teachers, professors, teaching assistants, educational administrators, counselors, and support staff, among others. The hallmark of education jobs is their focus on instructing and guiding students, shaping curricula, and contributing to the intellectual and social growth of individuals and communities. With a commitment to lifelong learning, professionals in this field often exhibit strong communication skills, a passion for teaching, and a dedication to the success of their students.
HR & Recruiting Jobs focus on attracting, hiring, and maintaining a workforce within an organization. These roles involve a multitude of tasks such as posting job openings, screening candidates, conducting interviews, managing employee relations, and ensuring compliance with labor laws. Key characteristics include strong communication skills, the ability to handle confidential information, and a knack for understanding both organizational needs and employee well-being. HR professionals not only optimize recruitment processes but also play a vital role in shaping company culture and fostering a productive work environment.
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Manufacturing or Operations jobs encompass roles involved in the creation of products and the management of production processes. These positions can range from machine operators, assembly line workers, and quality control inspectors to production managers and industrial engineers. Key characteristics include hands-on engagement with physical goods, adherence to safety protocols, a focus on efficiency and productivity, and often, the use of specialized machinery and technology. Manufacturing jobs can span a variety of industries, from automotive to electronics, and typically require a blend of technical skills, attention to detail, and the ability to work in a team-oriented environment.
