Claims Call Center Analyst I

Claims Call Center Analyst I at AllCare Health with the Claims department

***Please note- This is NOT a fully remote position***

• The employee must be able to work from the Grants Pass, Oregon office at least 2 days per week.
• The employee must be able to work from a home office up to 3 days per week (if they elect the work from home hybrid option).
• The employee may be able to work fully remote after the training period has been completed at the Hiring Manager's discretion.

We Are Seeking Qualified Candidates to Join Our Team!

AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and telecommute, remote work, and flexible schedule options.

Summary

This position requires primary focus on provider office phone calls or calls from their representatives. The position is responsible for maintaining provider/caller relationships by responding to phone inquiries and taking the appropriate actions for a 95% daily call resolution. This position requires primary focus on provider office phone calls or calls from their representatives by performing the following duties.

Essential Duties

• Documents the call in the incident module of the core claims system, reprocessing the claim if appropriate and providing excellent customer service.
• Responds to provider/caller inquires by understanding inquiries; reviewing previous inquiries and responses; gathering information and researching information; assembling and forwarding information; verifying customer’s understanding of information and answers.
• Accurately records every provider/caller inquiry by documenting inquiry and response in customer’ service module and claim notes as applicable.
• Accurately and efficiently adjudicate all professional claims applying benefits and pricing according to company policy, contract language and state Medicaid/Medicare guidelines.

Education & Experience

• Associate's degree (AA) or equivalent from a two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience.
• At least one year of Ez-Cap experience is preferred.

Certificates, Licenses, and/or Registrations

• A Professional Coder Certification is required or to be obtained within 12 months of hire date.

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties. The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate.

• The employee must be able to work from the Grants Pass, Oregon office at least 2 days per week.
• The employee must be able to work from a home office up to 3 days per week (if they elect the work from home hybrid option).

Company Overview

AllCare Health Website: https://www.allcarehealth.com.

AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp® status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/about-b-corps)

AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.

The AllCare Health family of businesses is guided by our corporate principles:

Purpose | Working together with our communities to improve the health and well-being of everyone.

Values | Trust, Innovation, Relationships, and Voice.

Vision | Thriving, Inclusive, and Equitable communities.

Brand Promise | Changing Healthcare to Work for You.

AllCare Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.