Claims/Healthcare Specialist

This is a training position where the incumbent is learning to perform the following functions in a competent manner.

Provide information and assistance needed to resolve problems experienced by practitioners in their various contractual relationships, including but are not limited to claims, pricing, or contracts.

Assist in providing training and continuing policy education on all facets of operations of provider staff and others as needed.

Conduct provider servicing and assist in the development and distribution of appropriate training materials, etc., as needed.

Submit reports on service and recruiting activities and other items as required by management.

Respond to fee requests from providers.

Provide ongoing development of database, reports and statistical analyses of managed care networks.

Create, modify and maintain new and existing reports to provide accurate information for both internal and external reporting.

Assist with the coordination and resolution of systemic problems and claim issues.

Develop and maintain a good working relationship with Core Services, Local Medical Directors, and other internal departments.

Coordinate with various departments as required for the recruitment, servicing and retention of contracted providers.

Establish working relationship with key facilities, physician groups, practice managers, IPAs, PHOs and other essential contacts.

Serve as liaison between facilities or provider office staff and various internal departments.

Maintain a high level of expertise in pricing arrangements, contract requirements/language, benefits, membership, claims processing, utilization review, etc.

Process provider change forms. Maintain tickler system and verify that all changes have been made in the appropriate system.

Prepare monthly reports and update provider databases as necessary.

Communicate and interact effectively and professionally with co-workers, management, customers, etc.

Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

Maintain complete confidentiality of company business.

Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

JOB REQUIREMENTS: Bachelor Degree OR 4 years work experience in the health care/insurance industry.

3 years experience in Network Management, Credentialing and/or Customer Service.

Understanding of health care contracts, applications and products.

Working knowledge of claims processing systems.

3 years experience utilizing a PC.

PREFERRED JOB REQUIREMENTS:

Knowledge of health care policies, products and procedures.

Dexian is a leading provider of staffing, IT, and workforce solutions with over 12,000 employees and 70 locations worldwide. As one of the largest IT staffing companies and the 2nd largest minority-owned staffing company in the U.S., Dexian was formed in 2023 through the merger of DISYS and Signature Consultants. Combining the best elements of its core companies, Dexian's platform connects talent, technology, and organizations to produce game-changing results that help everyone achieve their ambitions and goals.

• Dexian's brands include Dexian DISYS, Dexian Signature Consultants, Dexian Government Solutions, Dexian Talent Development and Dexian IT Solutions. Visit https://dexian.com/ to learn more.
• Dexian is an Equal Opportunity Employer that recruits and hires qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.

Job Types: Full-time, Contract

Pay: $25.97 - $30.77 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work setting:

• In-person

Experience:

• Customer service: 3 years (Required)
• Healthcare management: 3 years (Required)

Ability to Relocate:

• Richardson, TX: Relocate before starting work (Required)

Work Location: In person