Claims Specialist Quality Assurance I

Claims Specialist Quality Assurance I Location US-CA- ID 2026-6872 Category Finance Position Type Regular Full-Time Work Model Remote Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Claims Quality Assurance (QA) Manager and Supervisor, the Claims Specialist Quality Assurance (CSQA) is responsible for ensuring the integrity of all data created and updated by the Claims Processing staff. The CSQA will utilize quality auditing tools, identify training needs, and define effective and efficient methods for accurate data entry and adjudication. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities Review and assess data reports and audit Claim Processor output to confirm payment accuracy and completeness of data entry. In-house expert for claims adjudication (Coordination of Benefits, pricing, contract interpretation, coding, and resolution of claims issues.) Ensure that all identified errors are corrected in an expedient manner. Be an active participant in the Claims Department’s initiatives and participate in the Claims Coaching process, MDI activities, etc. Assist with the processing of claims when necessary to address claims backlogs. Process approved Stop Loss reimbursements. Any other duties as required, to ensure the success of the organization. Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance. Qualifications Education & Requirements Two (2) years of experience in examining and processing institutional and professional claims Medicare/Medi-Cal experience preferred Experience in a managed care environment helpful High school diploma or GED required Key Qualifications ICD-9/ ICD-10 and CPT coding and general practices of claims processing. Familiarity of Webstrat, Optum and CMS pricing Excellent communication and interpersonal skills, strong organizational skills Microcomputer skills, proficiency in Windows applications preferred Professional demeanor Start your journey towards a thriving future with IEHP and apply TODAY ! Work Model Location Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range USD $25.90 - USD $33.02 /Hr. Options Apply Apply Submit a Referral Refer Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Share on your newsfeed Connect With Us! Not Seeing What You’re Looking For? We invite you to join our Talent Network! Be the first to know about new opportunities that align with your interests and learn more about our mission to heal and inspire the human spirit. Application FAQs Software Powered by ICIMS www.icims.com