-
Specialist Dispute Resolution
5 days ago
Idaho State Job Bank Meridian, United StatesSpecialist Dispute Resolution at United Site Services in Meridian, Idaho, United States Job Description About USS You may not always notice United Site Services, but we are always there - at construction sites, industrial facilities, and live events all across America. We take pr ...
-
Customer and Sales Service Specialist HQ FG
2 weeks ago
Simplot Boise, United StatesThe J.R. Simplot Company is a diverse, privately held global food and agriculture company headquartered in Boise, Idaho. We are a true farm-to-table company with an integrated portfolio including food processing and food brands, phosphate mining, fertilizer manufacturing, farming ...
-
Client Support Specialist
2 weeks ago
Live Nation Worldwide, Inc. Idaho, United States Part timeTHE JOB · This position will support the Universe division within Ticketmaster. You will deliver services to support the client's day-to-day needs related to the use of ticketing systems and products. The CSS will be responsible for maintaining agreed upon service levels. They w ...
-
Field Service Technician II
1 week ago
Aventiv Technologies Boise, United States Full time** Heavy travel across the state of Idaho will be required for this role ** · Job Purpose: · Maintains and repairs telecommunication equipment, associated computers, networking, and electronic equipment and to install all Securus' products, features and equipment. Travels from ...
-
Benefits Specialist
3 weeks ago
Pennant Boise, United StatesWe are building a World Class Service Center and invite you to join a team of people who are committed to a core objective of supporting life changing service and providing professional expertise to the operations and leaders we support. · About the Company · Pennant Services is ...
-
IT Support Specialist
10 hours ago
Involta Boise, United StatesJob Summary: · The IT Support Specialist is primarily responsible for responding to client inquiries for technical assistance and ensuring courteous, timely and effective resolution of client issues. Problem resolution will involve the use of diagnostic and support request track ...
-
Sr. Employee and Labor Relations Specialist
5 days ago
Idaho State Job Bank Boise, United StatesSr. Employee and Labor Relations Specialist at Wolters Kluwer in Boise, Idaho, United States Job Description As a member of the Compliance and Employee Relations COE, the Employee & Labor Relations Specialist will provide compliance and employee relations guidance across the US o ...
-
Patient Account Representative-
3 days ago
SCA Health Boise, United StatesJob Description · Job DescriptionPatient Account Representative- - Treasure Valley HospitalJOB_DESCRIPTION.SHARE.HTMLCAROUSEL_PARAGRAPH · JOB_DESCRIPTION.SHARE.HTMLBoise, Idaho · Treasure Valley Hospital · Billing · Regular · Full-time · 2 · USD $20.00/Hr. · USD $23.00/Hr. · 3403 ...
-
Sr. Credit
5 days ago
Idaho State Job Bank Boise, United StatesSr. Credit & Collections Specialist - Remote at Sharecare, Inc. in Boise, Idaho, United States Job Description Job Description: Sharecare is the leading digital health company that helps people - no matter where they are in their health journey - unify and manage all their health ...
-
Technical Customer Support Tier 1
3 weeks ago
Hydropoint Data Systems, Boise, United StatesJob Description · Job DescriptionBoise, ID, USThis is a Temp opportunity · Requisition ID: 1016ApplySalary Range: 18.00 To USD) HourlyJob Description Summary: · We are currently seeking a motivated bilingual (Spanish-English), customer-oriented Tier 1 Technical Customer Support S ...
-
Senior Program Specialist, Engineering
5 days ago
Idaho State Job Bank Boise, United StatesSenior Program Specialist, Engineering & Facilities (Adminis at Marriott in Boise, Idaho, United States Job Description Additional Information Senior Program Specialist, Engineering & Facilities (Administrative) Job Number Job Category Administrative Location Marriott Internation ...
-
Customer Advocacy Sepcialist
5 days ago
Volt Boise, United StatesThis job was posted by : For more information, please see: Let Volt Help You Move Forward · Volt is immediately hiring for Customer Advocacy Specialist in Atlanta, Georgia · Job Overview: · Overview We are seeking a dedicated and detail-oriented individual to join our team as a ...
-
Specialist, Product Support
2 weeks ago
Idaho State Job Bank Boise, United StatesSpecialist, Product Support at Verint Systems, Inc. in Boise, Idaho, United States Job Description At Verint, we believe customer engagement is the core of every global brand. Our mission is to help organizations discover opportunities previously only scarcely imagined by connect ...
-
Idaho State Job Bank Boise, United StatesLearning & Development Specialist, Senior at Idaho Division of Human Resources in Boise, Idaho, United States Job Description Learning & Development Specialist, Senior Posting Begin Date: 2024/01/26 Posting End Date: 2024/02/11 Category: Human Resources Sub Category: Training Wor ...
-
Patient Relations Specialist
1 week ago
St. Luke's Health System Boise, Idaho, United States PermanentOverview: · St. Luke's Health System in Boise, ID is seeking a Patient Relations Specialist to join our Legal team. · Duties/Responsibilities: · Under general supervision, the Patient Relations Specialist will facilitate, review and resolution of patient grievances in a systemati ...
-
OTSI Boise, United States**Location** · Added - a day ago Customer Service Rep II Others Heredia, Heredia | Contract **Related Others Jobs** · Heredia, Heredia Heredia Heredia Heredia, Heredia Heredia, Heredia **Job Description** · **Were looking for a Customer Service Rep II** · What your role will ...
-
Claims Specialist
2 weeks ago
Idaho State Job Bank Boise, United StatesClaims Specialist (Hybrid - Eagan, MN) at Prime Therapeutics in Boise, Idaho, United States Job Description Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we ma ...
-
Patient Relations Specialist
1 week ago
St. Luke's Health System Boise, United StatesOverview · St. Luke's Health System in Boise, ID is seeking a Patient Relations Specialist to join our Legal team. · Duties/Responsibilities: · Under general supervision, the Patient Relations Specialist will facilitate, review and resolution of patient grievances in a systematic ...
-
Customer Care Specialist- Catlow
4 days ago
Idaho State Job Bank Boise, United StatesCustomer Care Specialist- Catlow - AMO at Vontier in Boise, Idaho, United States Job Description This individual will be expected to stay up to date with the knowledge required to handle standard Hanging Hardware phone calls received at the Tier 1 and Tier 2 levels. A portion of ...
-
AVP, Subrogation Complex Claim
5 days ago
Idaho State Job Bank Boise, United StatesAVP, Subrogation Complex Claim at Travelers Insurance Company in Boise, Idaho, United States Job Description Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as o ...
Claims Resolution Specialist - Boise, United States - Idaho State Job Bank
Description
Claims Resolution Specialist at Magellan Health Services in Boise, Idaho, United States Job Description This position is responsible for accurate and timely research of all claim dispute types, timely processing of adjustments and acts as liaison between members, providers and internal claims departments.
If a recalculation is warranted and modification to the payment amount is determined to be required, acting within established parameters, this role makes the appropriate payment adjustment into the claims system.
Must complete duties with a high level of detailed quality and professionalism. + Assists with claim dispute resolution through research and facilitating the resolution of the problem within contractual timeframes. + Acts as a troubleshooter to resolve claim processing problems among internal departments, including authorization issues. + Completes data entry for tracking and reporting of claim disputes. + Adjudicates claims and adjustments. + Assists in providing daily guidance for associates to obtain optimal results.+ Ensures documentation is entered into the appropriate system to ensure all pertinent information is recorded both for ease of resolution by the Claims Department and service continuation for the customer.
+ Processes adjustments to include tracking and trending performance of root cause analysis. + Updates members and providers with the disposition of payment as appropriate. + Identifies system/benefit errors completing protocols and workflows to prevent future errors. + Handles all types of requests, inquiries and complaints accurately and timely. + Provides re-enforcement training for new and existing associates as needed. + Responds to written correspondence and phone inquiries from internal customers. + Assists with handling internal routes (i.e. rates, provider membership issues). + Seeks, gathers and analyzes relevant data to address problems effectively.+ During peak call volumes, may provide back-up phone coverage from members and providers with inquiries related to eligibility, benefits, claims, authorization of services and/or other Magellan products and services.
Other Job Requirements Responsibilities Ability to review and interpret contract/account information to successfully resolve issues regarding claim disputes. Demonstrated ability for problem solving, meeting deadlines, showing initiative and follow-through. Must be a proficient typist. Working knowledge of Microsoft Office Product Suite, specifically Excel. Ability to simultaneously maneuver through various computer claims and eligibility platforms while verifying information while on the telephone. Excellent verbal and written communication skills. Must demonstrate professional call handling skills while under stress. Customer service oriented and a team player. Must maintain member and provider confidentiality at all times. Must be flexible in scheduling, be punctual and maintain good attendance. Understanding of customer service performance metrics (ASA, abandonment rate, talk time). Comfortable adapting to change. General Job Information Title Claims Resolution Specialist Grade 18 Work Experience - Required Claims, Customer Service Work Experience - Preferred Bilingual Education - Required Education - Preferred Bachelors License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $34,295Salary Maximum:
$51,445 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live.
Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants.
Copies of applicable posters are accessible by clicking here (.Warning:
Employment Scam It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health.
'Interviews' are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office.
Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices.
All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.
If you suspect you are being contacted by a false representative of Magellan Health, please call To view full details and how to apply, please login or create a Job Seeker account
