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Title: Temporary Claims Specialist II - Provider Claims Assignment Length: Six Months WORK LOCATION: 10801 6th St STE 120, Rancho Cucamonga, CA 91730 Key Responsibilities: Review and process provider dispute resolutions according to state and federal designated timeframes. Identify and report claim related billing issues to various departments for provider education Any other duties as required to ensure Health Plan operations are successful.

Title: Temporary Claims Specialist II - Provider Claims Assignment Length: Six Months WORK LOCATION: 10801 6th St STE 120, Rancho Cucamonga, CA 91730 Key Responsibilities: Review and process provider dispute resolutions according to state and federal designated timeframes. Review and assist with applying identified refunds submitted by the CART team. Research reported issues; adjust claims and determine the root cause of the dispute. Draft written responses to providers in a professional manner within required timelines. Independently review and price complex edits related to all claim types to determine the appropriate handling for each including payment or denial. Complete the required number of weekly reviews deemed appropriate for this position. Respond to provider inquiries regarding disputes that have been submitted. Maintain, track, and prioritize assigned caseload through IEHPs provider dispute database to ensure timely completion. Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed. Communicate with a variety of people, both verbally and in writing, to perform research, gather information related to the case that is under review. Recommend opportunities for improvement identified through the trending and analysis of all incoming PDRs. Coordinate with other departments as necessary to facilitate resolution of claim related issues. Identify and report claim related billing issues to various departments for provider education Any other duties as required to ensure Health Plan operations are successful. 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 Four (4) years of experience in a managed care environment in the area of claims processing; appeals & adjustments, and customer service, preferably in an HMO or Managed Care setting A thorough understanding of medical claim processing and customer service standards Medi-Cal/Medicare experience and prior experience in a lead role preferred High school diploma or GED required Key Qualifications Must have a valid California Driver's license Understanding of claim appeal process, provider contracts, claim system functionality and medical claim processing practices Strong analytical and problem-solving skills Microsoft Office, Advanced Microsoft Excel Microcomputer skills, proficiency in Windows applications preferred Excellent oral and written communication skills Excellent communication and interpersonal skills Customer service skills and skilled in data entry required Typing a minimum of 45 wpm Ability to build successful relationships across the organization Professional demeanor and strong organization skills High degree of patience

We are a $125 Million, NMSDC-certified Minority & Woman owned Workforce Solutions Company headquartered in the DC metro area with presence across US with global presence - Canada, Mexico, India, UK, Malaysia, Indonasia, Hongkong, Singapore, UAE. We are specialized in providing Workforce Solutions, SOW project delivery, Engineering Solutions, Creative Services. We currently support 100+ Fortune companies globally and across multiple industry segments. We are currently supporting several massive programs across industry segment nationally/globally (Intel, Ally, AMD, QUALCOMM, Morgan Stanley, Kraft/ Mondelez, MNP, Amdocs, Dell, SanDisk, Medtronic, Becton Dickinson, GE, Lockheed Martin, UTC, L-3 Communications, Caterpillar, BMW, Mercedes Benz, National Grid, Dominion, Energy Future Holdings, PSEG, 3M, Fidelity, Aetna, Humana, Johnson & Johnson, Pfizer, Merck etc). 
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status.

LanceSoft Inc

Temporary Claims Specialist II - Provider Claims

Analysis Skills

Billing

Claims Processing

Communication Skills

Customer Support/Service

Data Entry

Driver's License

Establish Priorities

HIPAA (Health Insurance Portability and Accountability Act)

Health Maintenance Organization (HMO)

Health Plan

High School Diploma

Identify Issues

Information/Data Security (InfoSec)

Interpersonal Skills

Managed Care

Medi-Cal

Medicare

Microsoft Excel

Microsoft Office

Microsoft Windows Operating System

Operations Planning

Organizational Skills

Presentation/Verbal Skills

Privacy Controls

Problem Solving Skills

Provider Contracting

Research Skills

Root Cause Analysis

Time Management

Training/Teaching

Trend Analysis

Typing

Writing Skills

ADAPTED_NOW

Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.). + Registers customer purchases on assigned cash register, collects cash and distributes change as requested; processes voids, returns, rain checks, refunds, and exchanges as needed.

HOUR

Job Description: + Models and delivers a distinctive and delightful customer experience. + Registers sales on assigned cash register, provides customers with courteous, fair, friendly, and efficient checkout service. Customer Experience + Engages customers and patients by greeting them and offering assistance with products and services. Resolves customer issues and answers questions to ensure a positive customer experience. + Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.). Operations + Provides customers with courteous, friendly, fast, and efficient service. + Recommends items for sale to customer and recommends trade-up and/or companion items. + Registers customer purchases on assigned cash register, collects cash and distributes change as requested; processes voids, returns, rain checks, refunds, and exchanges as needed. + Keeps counters and shelves clean and well merchandised, takes inventory, and maintains records. Checks in and prices merchandise as required or as directed by store manager or communicated by the shift leader. + Implements Company asset protection procedures to identify and minimize profit loss. + Ensures compliance with state and local laws regarding regulated products (e.g., alcoholic beverages and tobacco products). + Constructs and maintains displays, including promotional, seasonal, super structures, and sale merchandise. Completes resets and revisions as directed. + Assists with separation of food items (e.g., raw foods from pre-cooked) and product placement as specified by policies/procedures (e.g., raw and frozen meats on bottom shelves). For consumable items, assists in stock rotation, using the first in, first out method and restock outs. + Has working knowledge of store systems and store equipment. + Provides customer service in the photo area, including digital passport photo service, poster print and creative machine, suggestive sell of promotional photo products. + Assumes web pick-up responsibilities (monitors orders in Picture Care Plus, fills orders (pick items), delivers orders to customers as they arrive at store). + Assists with exterior and interior maintenance by ensuring clean, neat, orderly store condition and appearance. + Complies with all company policies and procedures; maintains respectful relationships with coworkers. + Completes special assignments and other tasks as assigned. Training & Personal Development + Attends training and completes PPLs requested by Manager or assigned by corporate. Job ID: 1679216BR Title: Customer Service Associate - Temporary Company Indicator: Walgreens Employment Type: Part-time Job Function: Retail Full Store Address: 1634 E HIGHLAND AVE,SAN BERNARDINO,CA,92404 Full District Office Address: 1634 E HIGHLAND AVE,SAN BERNARDINO,CA,92404-04616-06685-S External Basic Qualifications: + Must be fluent in reading, writing, and speaking English. (Except in Puerto Rico) + Requires willingness to work flexible schedule, including evenings and weekend hours. Preferred Qualifications: + Prefer six months of experience in a retail environment. + Prefer to have prior work experience with Walgreens. The following information is applicable for San Francisco, CA applicants: Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. An Equal Opportunity Employer, including disability/veterans. The actual compensation that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits . If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits Shift: Store: 06685-SAN BERNARDINO CA Pay Type: Hourly Start Rate: 16.5 Max Rate: 18

Founded over a century ago in 1901, we have a rich and colorful history of continuous improvement and innovation at Walgreens. From inventing the world’s first chocolate malted milkshake to the creation of one of the most popular and sophisticated mobile applications in retail shopping today, we have transformed ourselves into a leader within the retail and drug industry.
Walgreens, one of the nation’s largest drugstore chains, is included in the Retail Pharmacy USA Division of Walgreens Boots Alliance, Inc., the first global pharmacy-led, health well being enterprise.
At Walgreens you'll find a team positively energized by the unique talents, ideas, experiences and aspirations of every individual. In other words, you can be your authentic self in our stores, offices and other workplaces, and be comfortable and confident that what matters most here is doing your best to make health and well-being within reach for everyone on a daily basis.
Walgreens has a proud legacy of valuing diversity and fostering inclusion more than 100 years-strong, and we're still living that commitment. We intend to be recognized as a “Next Practices” company for diversity and inclusion – one whose cultures, people, perspectives and workplaces reflect the current and future customers we serve while delivering superior business performance.
Walgreens has over 9,500 stores in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.

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