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Claims Provider Services Representative I, South San Francisco, CA

Organization: Health Plan of San Mateo
Category: Professional
Location: South San Francisco, CA
Date Job Posted: January 9, 2020
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The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Claims Provider Services Representative I to help providers understand the policies and procedures in submitting claims, and assist in solving providers’ claim problems of a routine nature to ensure they are processed and paid on a timely basis. The essential duties & responsibilities will include the following:

  • Respond and handle high-volume of calls via call center queue, voicemails, emails and faxes from medical providers and others, answering their questions and assisting in the resolution of issues relating to claims submission and payment.
  • Research, identify, refer, resolve and follow-up regarding problems and notifying others of findings and provide recommendations for system or process improvement.
  • Document all actions in Call Log and respond to open issues in a timely manner.
  • Educate others regarding program information and proper medical claims billing procedures with the goal of improving and maintaining provider satisfaction.
  • Communicate newly-identified and potential issues to the Lead, Claims Managers and other departments as necessary.
  • Attend Team Meetings for ongoing training and development.
  • Perform other duties as assigned


Education and Experience: High school diploma/GED required. Associate of Arts degree preferred. Two (2) years’ experience working in a high-volume call center. One (1) year experience in a healthcare environment. Medi-Cal and Medicare experience preferred.

Knowledge of: Medicare and Medi-Cal programs. HCPCS, CPT, ICD-9 and Revenue coding. HIPAA regulations. Medical terminology. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint.

Ability to: Communicate effectively orally, in writing, and excellent phone skills. Be a self-starter. Independently solve problems and organize own workload according to department priorities and deadlines.

Compensation & Benefits

Starting Compensation Range: Depends on experience.

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.

How To Apply

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: or via fax: (650) 616-8039. File by: Continuous until filled. . EOE. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.

Submissions without a Cover Letter and salary expectations may not be considered

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