Claims Specialist Quality Assurance I

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Claims Quality Assurance (QA) Manager and Supervisor, the Claims Specialist Quality Assurance (CSQA) is responsible for ensuring the integrity of all data created and updated by the Claims Processing staff. The CSQA will utilize quality auditing tools, identify training needs, and define effective and efficient methods for accurate data entry and adjudication. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salaryState of the art fitness center on-siteMedical Insurance with Dental and VisionLife, short-term, and long-term disability optionsCareer advancement opportunities and professional developmentWellness programs that promote a healthy work-life balanceFlexible Spending Account – Health Care/ChildcareCalPERS retirement457(b) option with a contribution matchPaid life insurance for employeesPet care insurance Education & Requirements Two (2) years of experience in examining and processing institutional and professional claimsMedicare/Medi-Cal experience preferredExperience in a managed care environment helpfulHigh school diploma or GED required Key Qualifications ICD-9/ ICD-10 and CPT coding and general practices of claims processing. Familiarity of Webstrat, Optum and CMS pricingExcellent communication and interpersonal skills, strong organizational skillsMicrocomputer skills, proficiency in Windows applications preferredProfessional demeanor Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range $25.90 USD Hourly - $33.02 USD Hourly