Claims Intake Specialist

Gold Coast Health Plan will not sponsor applicants for work visas.

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

POSITION SUMMARY

A Claims Intake Specialist is responsible for the initial processing and review of claims submitted to an insurance company or medical provider. Their main role is to ensure that all claims are received, accurately recorded, and directed to the appropriate departments for further processing.

Work Schedule: Flexibility to work beyond normal business hours as needed.

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statements

* Receiving, Scanning and Sorting Claims: Organize incoming claims, whether in paper or electronic format, ensuring they are routed to the correct team or system.

* Data Entry: Input relevant information from claims forms into the system to initiate the processing workflow.

* Review for Completeness: Check for missing information, incomplete documentation, or errors in the claim forms that may delay processing.

* Communication: Contact providers or claimants to request additional information or clarify details, ensuring timely processing

* Tracking and Logging: Maintain a record of claims and monitor their progress to ensure timely handling.

* Ensuring Compliance: Follow established guidelines, standards, and regulations related to claim processing.

* Supporting the Claims Team: Assist claims examiners or processors by providing them with relevant documents and information.

POSITION QUALIFICATIONS

Competency Statements

* Analytical Skills: Ability to use critical thinking and reasoning to solve problems, ensuring efficient processing and sorting of incoming mail.

* Research Skills: Ability to design and conduct systematic investigations, when necessary, particularly for tracking lost or misdirected mail.

* Technical Aptitude: Proficiency in using and maintaining office equipment such as mail sorting machines, scanners, and computers, along with basic office software for tracking and managing mail.

* Problem Solving: Ability to proactively address and resolve work-related challenges, such as missing or delayed mail, in an effective and timely manner.

* Diversity Oriented: Ability to work effectively with people of varying backgrounds, age, gender, race, ethnicity, religion, or job roles, promoting a respectful and inclusive environment.

* Time Management Skills: Ability to manage time effectively to prioritize and complete mail sorting and delivery tasks within established deadlines.

* Ethical: Demonstrates conduct that aligns with a set of values and accepted standards, maintaining confidentiality and security of sensitive or confidential mail.

* Judgment: The ability to make sound decisions using available information, especially when dealing with important or urgent mail.

* Communication, Oral: Ability to effectively communicate with colleagues and recipients using clear, concise verbal communication.

* Communication, Written: Ability to accurately record and communicate mail-related information in writing, ensuring clarity and proper documentation.

* Honesty / Integrity: Ability to maintain honesty and trustworthiness in the workplace, ensuring that all mail handling is done with the highest level of integrity.

SKILLS & ABILITIES

Education: High School Graduate or General Education Degree (GED): Required

Experience:

* 2 or more years of mailroom and/or data entry experience

* Prior experience with Medi-Cal claims is preferred

* Medi-Cal/Medicaid managed care experience strongly desired.

Computer Skills: Intermediate computer skills included in the MS Office products.