Job Description

Our Mission:  Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.

Our Vision: 

Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.

Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!

Position Purpose:    Claims Lead- Interdepartmental Oversight is to act as a liaison between Reimbursement Services and other internal departments to help ensure communication and operational efficiencies.

Responsibilities:   

  • Track, monitor progress and ensure issue resolution for internal departments and priority claims through different internal processes from receipt to final disposition.  Tracking may include mailroom/sftp sites, Network, data entry, scanning, fee schedule loads / updates, benefit configuration, claims processing, medical claims review, internal audit, final denial/paid date and notification to provider
  • Develop and implement pathways between departments for operations
  • Assist in ensuring claims turnaround time and accuracy goals are met in regards to High Dollar/Priority Claims.  Interdepartmental Lead may also assist in processing claims, including high priority claims, which are inclusive of transplants
  • This position may assist the Supervisor(s) with daily operations, as well as assisting with training and documentation
  • Provide feedback to the supervisor(s) and trainer, through written and verbal documentation/communications, regarding claims issues, process improvements and other areas of concern 

Education / Experience / Other Requirements

Education:   

  •    High School Diploma or GED
  • Associates Degree Preferred

Years of Experience:  

  • Three (3) years claims processing experience in CMS 1500, UB and electronic claims in a managed care environment

Specialized Knowledge:  

  • Claims Processing, 1500s and UBs
  • Knowledge of medical terminology
  • Knowledge of ICD-10
  • Knowledge of CPT Codes and HCPCS codes
  • Understanding of internal operations of managed care environment
  • Ability to supervise and lead others
  • Ability to think analytically and make independent decisions
  • Ability to manage large workload
  • Ability to maintain positive work relationships
  • Handle multiple and changing priorities at a fast pace
  • Work cooperatively, positively, and collaboratively in an interdisciplinary team
  • Computer experience necessary, including Excel
  • Effective time management and organizational skills
  • Effective interpersonal and communication skills

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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