Claims Technician II

Location: Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California

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

The Claims Technician II is the full working level in the Claims Technician series and is distinguished from the lower, entry and first working level Claims Technician I by the former's responsibility for verifying, processing, and adjudicating both Level I and II claim types. The Claims Technician II is distinguished from the higher, advanced working level Claims Technician III by the latter's responsibility for processing Level III claim types and training and acting as a resource to Claims Technicians I and II.

Applications will close Friday 5/16 at 5pm PT.

This position is open to current Claims Technician Temps II that are meeting their production metrics or any internal employees.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Claims Supervisor you will:

• Verify, process, and/or adjudicates claims, including applying detailed consideration, standards in pending and releasing claims from pend edits and for proper application of program policy related to claim entry and analysis
• Assist with training new hires and cross-training other Claims Technicians
• Perform claims data entry, with duties including verifying the accuracy of the data entry performed by internal staff and providers

ABOUT THE TEAM

We support Alliance members' access to care by ensuring medical services are paid to network providers accurately and on time.

WHAT YOU'LL NEED TO BE SUCCESSFUL

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

Knowledge of:

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  • 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
  • Medical insurance Explanation of Benefits
  • General office equipment, including personal computer, telephone, photocopier, fax, etc. Systems such as Windows-based PC systems, including Microsoft Word, Excel, and Outlook
  
  
  
  
• Ability to:
  
  
  
  
  • Utilize a variety of computer systems, including Alliance systems and external web sites and databases
  • Keep current on claims processing practices and procedures
  • Read and understand medical insurance Explanation of Benefits
  
  
  
  
• Education and Experience:
  
  
  
  • High school diploma or equivalent and a minimum of two years of administrative experience, including one year of medical claims processing or medical billing 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