HMO Claims Customer Service Representative - Claims Processing - Position #2022-475


Date Posted:
Full Time
OPEN UNTIL FILLED Redlands Monday - Friday 6:00a.m. - 2:30p.m.

Job Description

The HMO Claims Customer Service Representative is responsible for successfully managing large amounts of inbound calls. This will include following communication scripts, handling different topics related to claims & health care, and acting as a liaison between our company and its customers. In addition, you will be responsible for evaluating documents to ensure that appropriate information has been obtained for payment purposes.


High School diploma or equivalent. Course work and knowledge of medical terminology preferred. Inbound & Outbound calling experience in a call center, medical office/clinic, hospital institution setting or one year of claims adjudication experience in a Managed Care/IPA environment. Two years of claims adjudication experience in a Managed Care/IPA Claims environment with Customer service call center knowledge preferred.  Must have excellent verbal, written and interpersonal communication skills.  Must be proficiently skilled in the application and use of Windows, Excel, Outlook and the Internet. Knowledge of some medical terminology, ICD9 and CPT/HCPCS codes required; clerical ability necessary, including ten-key calculator, computer, and light (35 wpm with accuracy) typing skills.

Beaver Medical Group requires all new hires and employees to report their COVID-19 vaccination status

Applications must be complete and demonstrate that the minimum qualifications are met. Resumes may be attached to completed application form as supplemental information, but will not be accepted in lieu of an official application form. Applications will be screened and the most qualified candidates who best match the needs of the position will be invited to compete further in the recruitment process.  Due to the large volume of applications received, we are unable to track for individual applications or discuss the application process.