Claims Specialist

Title: Claims Network Operations Coordinator

Location: 100% on site M-F-970 W. 190th Street, Floor 4, Torrance, California 90502

Types of position: Contract

Duration: 8 months contract with Possible extensions

Job Description

The Network Operations Coordinator 2 maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Network Operations Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

The Network Operations Coordinator 2 manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Required Qualifications

Less than 3 years of technical experience

Proficiency in MS Office applications

Possess a strong attention to detail

Ability to work in a deadline driven environment

Strong verbal and written communication skills

Previous account management, project management or related experience

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Associates or Bachelors Degree

Prior experience working in the insurance industry

Proficiency in MS Access

Previous experience in claims

Prior contract interpretation experience strongly desired

Previous provider experience (provider contract, provider relations, or provider service).

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status.