Lead Claims Processor - Inland Empire Health Plan : Job Details

*Job Overview*Find out if this opportunity is a good fit by reading all of the information that follows below.Under the direction of the Claims Manager and Supervisor, the Lead Claims Processor is responsible for fulfilling the technical support needs of claims processing staff and handling complex claims. This includes but is not limited to; high dollar, dialysis, oncology/chemo, hospital exclusions and claim adjustments in an accurate and expedient manner. Additional duties include assistance with claim inventory control and regulatory audit needs. The Lead Claims Processor has direct communication with other internal and external business units in an effort to resolve claim issues or obtain process clarification.Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.*Education & Experience** Minimum of four (4) years of experience in adjudicating inpatient and outpatient professional and institutional medical claims* Experience preferably in an HMO or Managed Care setting* Medicare and/or Medi-Cal experience preferred* Prior experience in a lead role or customer service environment is a plus* High School Diploma or GED required*Key Qualifications** Must have a valid California Driver's license* Advanced knowledge of medical claim processing requirements* Microcomputer skills, proficiency in Windows applications preferred. Excellent communication and interpersonal skills. Strong organizational skills required* Professional demeanorJob Type: Full-timePay: $57,054.40 - $74,172.80 per yearBenefits:* 401(k)* Dental insurance* Health insurance* Life insurance* Paid time off* Vision insuranceSchedule:* 8 hour shiftExperience:* inpatient and outpatient claims determination: 4 years (Required)Location:* California (Required)Work Location: RemoteRemote working/work at home options are available for this role.