Providence is calling a Claims Specialist 3 to Providence Health Plan in Beaverton, OR.
In this position, you will:
- Process claims for Providence Health Plans' customers with superior claims service to support Health Plans operations.
- Be responsible for processing claims for members, providers, and employers.
- Be responsible for communications with existing and potential members, providers, and employers.
- Provide and interpret detailed benefit, eligibility, and premium information on a broad portfolio of products, responds to claim inquires, and resolve member issues or concerns.
- Correctly analyze and adjudicate claims to reflect financial, check, and processing accuracy.
- Initiate and facilitate member, provider, and employer phone calls to the Providence provider entities, pharmacy department, employer groups, sales and producers in an efficient manner for claims resolution.
- Possess the collaborative skills necessary to perform well in a team environment.
- Have mastered the majority of pend/error types with a deep expertise in file reviews, complex claims adjustments, and various reports/projects.
- Assist in auditing, mentoring, training claims processors with questions to coordinate training needs.
- Answer team questions as a back up to the Technical Specialist.
Required qualifications for this position include:
- High school diploma or equivalent plus 2 years experience with healthcare customer service and/or claims, accounting
- Must have held a Claims Specialist 2 position for a minimum of 12 months
Preferred qualifications for this position include:
- Bachelors degree plus 1 year of experience in healthcare customer service and/or claims, accounting
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. 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.
Job Category: Health Plans
Req ID: 154460