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Claims Resolution Specialist (Customer Service)

Company: The Judge Group
Location: Orange
Posted on: September 14, 2022

Job Description:

Location: Orange, CA Description: The Judge Group is currently seeking a Claims Resolution Specialist (Customer Service) for one of our clients in Orange, CA! This job will have the following responsibilities:

  • Address provider inquiries, questions, concerns in all areas including enrollment, claims submission and payment, benefit interpretation, and referrals/authorizations for medical care.
  • Verifies member eligibility, claims, and authorization status for providers. -
  • Responsible for thorough follow-up and completion of all providers inquires or requests.
  • Outreaches to Health Network(s), providers, and collection agencies when appropriate to resolve claims billing, claims payment, and provider payment disputes. -
  • Functions efficiently and productively in a high-volume call center while maintaining departmental productivity and quality standards. -
  • Follows up with providers as needed. -
  • Responsible for accurate, complete, and correct documentation into facets regarding all issues, inquiries, complaints, and grievances. -
  • Routes escalated calls to the appropriate departments and/or supervisor. -
  • Adheres to company and departmental policies and procedures. -
  • Other duties or projects as assigned by management. Qualifications & Requirements:
    • 1+ year call center experience with high call volumes or customer service experience analyzing and solving provider claims problems required
    • 2+ years of claims experience required
    • Health Maintenance Organization (HMO), Medicare, Medicaid, and Health Services experience preferred If you'd be interested in this role and would like to learn more please email me at kgould@judge.com, or call my direct line at (214) 281-5946 for immediate consideration. Contact: This job and many more are available through The Judge Group. Find us on the web at

Keywords: The Judge Group, Orange , Claims Resolution Specialist (Customer Service), Other , Orange, California

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