Providence St. Joseph Health is calling a Claims Specialist 1 to our location in Beaverton, OR.
We are seeking a Claims Specialist 1 to process claims for members, providers, and employers. In addition to claims processing the Specialist One provides and interpret detailed benefit, eligibility, and premium information on a broad portfolio of products, responds to claim inquires, and resolve member issues or concerns. The Claims Specialist 1 will correctly analyze and adjudicate claims to reflect financial, check, and processing accuracy.
Prioritizing individual workload to meet deadlines, fluctuations in claim and rapidly changing priorities.
Consistently maintain productivity and accuracy standards in a highly detailed environment and multiple based systems.
Empathize with customer concern and explain benefits, eligibility rules, and premium payment policies in a detailed manner so they are easily understood and in a courteous manner while meeting team performance standards.
Maintain current knowledge of complex regulations as they may differ by product line
Determines the appropriate application of regulatory requirements at all times.
In this position you will have the following responsibilities:
Process all claims entry level to intermediate in all categories in a minimum of one product, as defined by Providence Health Plans.
Process pends and error codes. Research and resolve pended claims.
Work team reports, 28 day delay report, overpayment reports, retro referral report, retro authorization report, split reports, missing image reports, PPO/no EPO report, daily aging reports, PHS reports, and co-payment reports.
Handle incoming mail, provider appeals, inquires, and tracers. Review member correspondence and process or direct to the appropriate department.
- 2 years experience with CLAIMS or Customer Service or accounting.
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits — see our website for details — http://www.providenceiscalling.jobs/rewards-benefits
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Customer Service
Req ID: 362827