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Claims Specialist


This is a Contract position in Fresno, CA posted January 23, 2021.

Description: The ECS Claims Analyst position will be responsible for accurately processing PCP, Specialty and Hospital claims in a computerized on-line environment. Responsibilities include the handling of member/provider phone inquiries on a needed basis. 1. Processes PCP, specialty and hospital claims in an on-line environment to meet or exceed production and quality standards. 2. Identifies eligibility and COB problems and routes to member services. 3. Identifies PCP assignments and routes to member services. 4. Manages pends and routes to ensure timely processing is met. 5. Processes multiple payment methodologies to ensure claims are processed accurately. 6. Reads and interprets contracts to identify benefits and appropriate financial responsibility. 7. Submits claims to corporate offices for payment on shared risk accounts, aids, indemnified and transplant pools. 8. Identifies and refers appropriate claims to Utilization Management for approval, authorization and payment determination. 9. Handles refund checks, makes adjustments to claims and works stat reports as needed. 10. Maintains confidentiality of sensitive information. 11. Attends meetings as required. 12. Provides continual assessment and improvement of work processes. 13. Maintains effective communication with team members and managers. 14. Handle member/provider phone inquiries when CSR assistance is needed. 15. Anticipates and exceeds customer expectations. 16. In the spirit of teamwork, employees are expected to follow any other job-related instructions and to perform any other job-related duties as requested. Additional Skills & Qualifications: Knowledge of claims processing in a Managed Care setting. Skill in operating a computer and photocopy machine. Ability to handle large volumes of work expediently and accurately. High School Diploma/GED equivalent required. Previous processing of medical claims, preferably in a computerized environment. Minimum 6-12 months medical claim processing experience or related degree preferred. About Aerotek: We know that a company’s success starts with its employees. We also know that an individual’s success starts with the right career opportunity. As a Best of Staffing® Client and Talent leader, Aerotek’s people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek’s 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.