Claims Processor

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn; Facebook; and Twitter.

The Job

Conducts evaluation and triage of incoming provider inquiries through the SCAN Health Plan Provider Portal, research the issues and respond to the provider with resolution. Interact with internal SCAN departments necessary to resolve inquiry including identification of issues requiring escalation to department leads for assistance with resolution. May also assist with Provider dispute triage and Claims mailroom triage functions as needed.

You Will

• Manage a case load of provider inquiries through the provider portal as assigned or as fetched from the general queue.
• Interpret and understand simple to complex issues sent by provider.
• Manage case load to established timeliness and quality standard for provider portal process.
• Navigate SCAN departments to facilitate resolution as necessary.
• Utilize SCAN systems to resolve issues, including, but not limited to iKA, MedHOK, internal databases and Outlook.
• Identify issues during the intake process which present complex issues and may require additional assistance, escalate issue as soon as identified.
• Participate in Provider Medical Group (delegated) or contracted provider meetings as required.
• Present metrics, issue analysis or pertinent information to Claims leadership as required.
• Maintain timely response and provide follow up emails to providers when resolution requires additional time.
• Analyze and identify root cause issues to escalate to Claims team leadership.
• Triage provider dispute resolution cases when needed to support the provider dispute resolution analysts as needed.
• Support and assist the claims mailroom triage process as needed or to backfill for regular staff absences.
• Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Contribute to team effort by accomplishing related results as needed.
• Actively support the achievement of SCAN's Vision and Goals.
• Other duties as assigned.

Your Qualifications

• Associate's degree in Business Administration or related field
  
  
  
  • comparable combination of education/experience and/or training will be considered equivalent to the education
  
  
  
  
• 2-3 years of Claims experience
• 2-3 years of general office experience
• Excellent organizational skills and a demonstrated focus on accuracy and attention to detail.
• Knowledge of medical terminology, coding, claims policies and procedures, workflow, standard coding and reference publications, CPT, ICD-9, DRG, etc. is beneficial.
• Knowledge of HIPAA regulations and privacy laws.

What's in it for you?

• Base Pay Range: 20.14 - $32.21 (Hourly)
• Work Mode: Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• 11 paid holidays per year, plus 1 additional floating holiday
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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