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Intermediate Group Level Processor Job
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Employer Name: |
SpiderID: 13795689 |
Location: Lodi, California |
Date Posted: 7/21/2024 |
Wage: Negotiable |
Category: Insurance |
Job Code: 170027Q-2191 |
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Job Description: Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California's Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.
Description:
Internal Job Description: Process health plan related data and information using automated systems within established production and quality standards. Process group level changes such as renewals, new group installations, billing unit updates, group name, and address changes, benefit and rate information updates. Identifies and resolves issues with enrollment information and member eligibility.
Responsibilities: • Verifies accuracy of entered data against source documents • Researches information as appropriate to resolve problem encounters • Regularly contacts internal and external customers and business partners to verify or obtain additional information to complete processing work • Makes decisions based on review of source documents for routine and difficult processing issues • Assists with duties as required to support department on an as-needed basis • Accesses and updates many complex computer screens • May be assigned specialized tasks and projects • May be asked to review documentation and provide feedback • Adheres to state and federal regulations • May act as mentor to new team members
Problem Solving/Decision Making: • Works under minimal supervision and responsible for assignments that range from routine to moderately complex. • Identifies & researches discrepancies affecting eligibility and/or allocations of payments • Ability to work within a team environment • Preferred experience in a production environment • Must have good decision-making skills to make processing specific decisions • Provides feedback to supervisor regarding system or procedural problems
Qualifications:
Knowledge, Skills, Competencies: • Ability to enter and retrieve data using standardized keyboard functions • Ability to read and interpret technical procedures or government regulations • Good verbal and written communication skills with ability to write correspondence • Good knowledge of windows based applications (Outlook, Word & Excel) • Strong attention to detail • Good analytical skills • Problem solving ability • Adaptability to change • Ability to multi-task • Ability to maintain confidentiality • Ability to identify issues and escalate as appropriate • Ability to work independently to identify issues and takes corrective action • Some knowledge of medical plans and benefits preferred • Effective critical thinking skills • Strong customer service skills • Minimum Education: High School Diploma or GED
Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:
Contact Information:
Contact Name: Blue Shield of California |
Company Type: |
Company: Blue Shield of California |
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