Healthcare Claims Resolution Representative at Randstad USA

Healthcare Claims Resolution Representative (Customer Service)

Position Overview

We are seeking a detail-oriented and experienced Healthcare Claims Resolution Representative to join our team in Orange, CA. This role is perfect for a professional who thrives in a fast-paced environment and possesses a deep understanding of the managed care landscape. You will serve as the primary point of resolution for complex claims inquiries, ensuring our members and providers receive accurate and timely information.

Pay Rate: Starting at $25.00/hour (Increases based on experience)

Location: 100% Onsite – 505 City Parkway West, Orange, CA 92868

Schedule: Monday – Friday | 8:00 a.m. – 5:00 p.m.

Essential Duties & Responsibilities

• Provide high-level customer service by resolving complex claims disputes and inquiries via telephone in a high-volume call center environment.
• Navigate HMO, Medi-Cal/Medicaid, and managed care regulations to provide accurate claim status and adjudication details.
• Analyze billing and claims data to identify errors, processing delays, or payment discrepancies.
• Collaborate with internal departments to facilitate the timely resolution of provider and member issues.
• Maintain meticulous documentation of all interactions and resolutions in accordance with compliance standards.

Minimum Qualifications

• Education: High school diploma or equivalent.
• Experience: * 2 years of direct experience in Claims Resolution required. (A combination of relevant higher education and experience may be considered).
• 1 year of Call Center experience handling high call volumes or equivalent high-touch customer service experience.
• 1 year of specific experience with HMO, Medi-Cal/Medicaid, and Healthcare/Managed Care environments is mandatory.

Skills & Abilities

• Strong knowledge of medical terminology and claims processing workflows.
• Exceptional verbal and written communication skills.
• Proficiency in navigating multiple software systems and healthcare databases simultaneously.
• Ability to remain professional and empathetic while managing challenging conversations.

Work Environment

This is a 100% onsite position located in our Orange, CA office. Candidates must be able to commute to the office daily for the 8:00 a.m. – 5:00 p.m. shift.

How to Apply: [Insert Application Link or Email Address Here]

We are an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.