Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion:  PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Work collaboratively with department leadership to identify staff training needs.

Essential Responsibilities:

Perform claim audits on work completed by researching appropriate benefits, reimbursement contracts, claim edits, system configuration, and desktops, as well as policies and procedures for processing all types of claims. Provide immediate feedback on claims with errors to claims analysts and team leaders.Engage with department leadership team to plan and/or deliver continued education to address new claims processing situations or areas identified as “needs improvement”.Develop, update, and maintain department specific training materials, policies, and desktop procedures. Track aging status of existing documentation and ensure timely updates in order to keep the documentation current.Actively participate in process improvement initiatives to ensure efficiency, accuracy, and effectiveness in the department.Document issues benefit, configuration, issues that affect claims processing/analyzing and advise appropriate internal personnel of processing concerns and/or problems.Provide training to new hires and perform ongoing training within the Claims department.Analyze data and produce accurate and timely productivity, quality and statistical reports as assigned by department manager.Request reports and queries on an as needed basis to assist with identifying and resolving discrepancies and to provide claims for training purposes.Work collaboratively with internal business partners to identify issues that require remediation. Assist with testing, validation of configuration changes and monitor the results of new functionality to ensure efficiency and effectiveness. Provide claims processing and/or adjustment processing for claims in claims processing queues, tasks, emails, OnBase queues when/if training and documentation duties are up-to-date.Provide support to department staff and internal customers to answer questions regarding claims processing rules and processes. Assist in claim grievance and appeal research and resolution. .Develop and maintain positive relationships with vendors that contract with PacificSource for claims related services. May communicate via phone, email, or business letter.Develop training materials and deliver one-on-one or group training to other claims analysts using Lean training techniques as assigned.Actively participate in claims processing as needed when not training.

Supporting Responsibilities:

Participate in team and department meetings, mentor training and team building activities. Represent Claims Department in inter-departmental workgroup meetings as assigned.Demonstrate ability to delegate or seek assistance when needed from other resources or subject matter experts within PacificSource.Meet department and company performance and attendance expectations.Perform other duties as assigned.

SUCCESS PROFILE

Work Experience:

3 years in health insurance or related experience required. Claims processing knowledge is preferred. Previous instruction or experience in training others is preferred.

Education, Certificates, Licenses:

High school diploma or equivalent required.

Knowledge:

Requires experience with, and detailed knowledge and understanding of Facets claims processing, Coordination of Benefits and department workflow. Ability to understand and interpret PacificSource contract provisions applicable to the expanded service area. Average to advanced skills in Microsoft PowerPoint, Excel, Word, Visio and Outlook. Intermediate level or above experience with ICD-10 and CPT coding, and medical terminology are required. Knowledge of government programs claims processing is helpful. Requires strong written documentation skills. Must have the ability to develop and deliver appropriate training based presentations to department staff.

Competencies:

Building Customer Loyalty

Building Strategic Work Relationships

Contributing to Team Success

Planning and Organizing

Continuous Improvement

Adaptability

Building Trust

Work Standards

Environment:

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

We are committed to doing the right thing.We are one team working toward a common goal.We are each responsible for customer service.We practice open communication at all levels of the company to foster individual, team and company growth.We actively participate in efforts to improve our many communities-internally and externally.We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.