Blank Assistant 3

Job Summary

#CA-DK

The Claims Inquiry Representative serves as a contact for Primary Care Physicians, Staff Specialists, Contracted Specialists, and their management staff for resolving issues related to claims payment activities.

The Claims Inquiry Representative also serves as a contact for members, health plan representatives, other insurance carriers and attorneys for resolving the same type of activities.

This incumbent's work is performed independently, based on prior agreements and arrangements and subject to administrative review and approval.

The incumbent's will receive direction concerning overall goals and objectives of the department and effectively recommend action to achieve goals.

Apply By January 16, 2025 at 11:59 pm

Minimum Qualifications

For full consideration, applicants are encouraged to upload license and/or certification if required of the position

• Data entry/data base management and claims adjudication experience.
• Demonstrated customer service orientation and experience.
• Demonstrated strong analytical and problem-solving skills.Skills to research complex problems and follow them through to resolution.
• Organizational skills to prioritize tasks.Good mathematical skills and understanding of medical accounting procedures.
• Knowledge of administration of benefits for multiple lines of health plan businesses, including full risk capitation programs, Medicare Risk, and point-of- service.
• Demonstrated good verbal and written communication skills, documenting and reporting clearly and concisely. Conveys instructions, directions, and information appropriately.
• Familiarity with managed care, Medical, and Medicare program requirements, trends, and issues in the health care industry.

Key Responsibilities

• 60% - Claims Inquiry
• 20% - Internal and External Claims Processing
• 15% - Report Research
• 5% - Mail Desk Support

Department Overview

Managed Care Operations serves as the central management point for all capitated HMO contracts providing services for both Members and Providers, including claims, eligibility and member services.

UC Davis Health serves approximately 64,000 members, representing approximately $11,000,000 in monthly capitation revenue.

POSITION INFORMATION

• Salary or Pay Range: $28.49 - $40.83
• Salary Frequency: Hourly
• Salary Grade: 108
• UC Job Title: BLANK AST 3
• UC Job Code: 004722
• Number of Positions: 1
• Appointment Type: Staff: Career
• Percentage of Time: 100%
• Shift Hours: 8am-5pm
• Location: Armstrong Building (OTH167)
• Union Representation: CX-Clerical/Admin
• Benefits Eligible: Yes
• This position is hybrid (mix of on-site and remote work)
• THIS IS NOT AN H-1B VISA OPPORTUNITY

Benefits

Outstanding benefits and perks are among the many rewards of working for the University of California. UC Davis offers a full range of benefits, resources and programs to help you bring your best self to work, as well as to help you and your family achieve your health, wellness, financial and career goals. Learn more about the benefits below and eligibility rules by visiting either our handy Benefits Summary for UC Davis Health Employees or Benefits Summary for UC Davis Employees and our Benefits Page.

If you are represented by a union, benefits are negotiated between the University of California (UC) and your union and finalized in a contract. Read your bargaining unit's employment contract, stay abreast of current negotiations and learn about collective bargaining at UC: https://ucnet.universityofcalifornia.edu/labor/bargaining-units/index.html

High quality and low-cost medical plans to choose from to fit your family's needs

UC pays for Dental and Vision insurance premiums for you and your family

Extensive leave benefits including Pregnancy and Parental Leave, Family & Medical Leave

Paid Holidays annually as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement

Paid Time Off/Vacation/Sick Time as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement

Continuing Education (CE) allowance and Education Reimbursement Program as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement

Access to free professional development courses and learning opportunities for personal and professional growth

WorkLife and Wellness programs and resources

On-site Employee Assistance Program including access to free mental health services

Supplemental insurance offered including additional life, short/long term disability, pet insurance and legal coverage

Public Service Loan Forgiveness (PSFL) Qualified Employer & Student Loan Repayment Assistance Program for qualified roles

Retirement benefit options for eligible roles including Pension and other Retirement Saving Plans. More information on our retirement benefits can be found here

UC Davis cares about building a community, which is why we provide resources to enhance diversity, equity and inclusion as well as Employee Resource Groups (ERGs) to support our staff

Physical Demands

• Standing - Occasional Up to 3 Hours
• Walking - Occasional Up to 3 Hours
• Sitting - Frequent 3 to 6 Hours
• Lifting/Carrying 0-25 Lbs - Occasional Up to 3 Hours
• Pushing/Pulling 0-25 Lbs - Occasional Up to 3 Hours
• Bending/Stooping - Occasional Up to 3 Hours
• Squatting/Kneeling - Occasional Up to 3 Hours
• Twisting - Occasional Up to 3 Hours
• Reaching overhead - Occasional Up to 3 Hours
• Keyboard use/repetitive motion - Frequent 3 to 6 Hours

Mental Demands

• Sustained attention and concentration - Frequent 3 to 6 Hours
• Complex problem solving/reasoning - Occasional Up to 3 Hours
• Ability to organize & prioritize - Frequent 3 to 6 Hours
• Communication skills - Frequent 3 to 6 Hours
• Numerical skills - Occasional Up to 3 Hours
• Constant Interaction - Frequent 3 to 6 Hours
• Customer/Patient Contact - Frequent 3 to 6 Hours
• Multiple Concurrent Tasks - Frequent 3 to 6 Hours

Work Environment

UC Davis is a smoke and tobacco free campus effective January 1, 2014. Smoking, the use of smokeless tobacco products, and the use of unregulated nicotine products (e-cigarettes) will be strictly prohibited on any UC Davis owned or leased property, indoors and outdoors, including parking lots and residential space.

Position may be required to work overtime, if necessary.

Special Requirements - Please contact your recruiter with questions regarding which activities apply by position

• This is a critical position, as defined by UC policy and local procedures, and as such, employment is contingent upon successful completion of background check(s), including but not limited to criminal record history background check(s)
• This offer is contingent upon your successful completion of an Employment Misconduct Disclosure review where you will be required to disclose any final administrative or judicial decisions within the last seven years determining that you committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct requirements
• This position is designated as a mandated reporter under CANRA and UC policy, and employment is contingent on compliance with applicable policies, procedures and training requirements

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

Diversity, Equity, Inclusion and Belonging

At UC Davis, we're solving life's most urgent challenges to bring a fuller, healthier, and more resilient world within reach. We grow from every challenge we take on and we don't just maintain - we improve. We recognize that creating an inclusive and intellectually vibrant organization means understanding and valuing both our individual differences and our common ground. The most comprehensive solutions come from the most diverse minds and you belong here. As you consider joining UC Davis, please explore our Principles of Community, our Clinical Strategic Plan and strategic vision for research and education, and our latest efforts to outgrow the expected. The University of California, Davis is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California's Affirmative Action Policy, please visit: https://policy.ucop.edu/doc/4010393/PPSM-20

For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

Because we want you to be seen, our recruiting process at UC Davis fosters authenticity, diversity, and inclusion. Studies have shown that some people may not apply to jobs unless they meet every single qualification. Each unique role at UC Davis has a set of requirements and you could be perfect for this role, or you could be perfect for the next role! Don't meet all the requirements? We still encourage you to apply! #YouBelongHere

To learn more about our background check program, please visit: https://hr.ucdavis.edu/departments/recruitment/ucd/selection/background-checks


To apply, visit https://careerspub.universityofcalifornia.edu/psc/ucdmed/EMPLOYEE/HRMS/c/HRS_HRAM_FL.HRS_CG_SEARCH_FL.GBL?Page=HRS_APP_JBPST_FL&JobOpeningId=75276&PostingSeq=1&SiteId=5〈uageCd=ENG&FOCUS=Applicant

The University of California is an Equal Opportunity/Affirmative Action Employer advancing inclusive excellence. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC nondiscrimination policy.





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About University of California Davis Health System

UC Davis is the home of the Aggies — go-getters, change makers and problem solvers who make their mark at one of the top public universities in the United States. Since we first opened in 1908, we’ve been known for standout academics, sustainability and Aggie Pride as well as valuing the Northern California lifestyle. These themes are woven into our 100-plus-year history and our reputation for solving problems related to food, health, the environment and society.Our 5,300-acre campus is in the city of Davis, a vibrant college town of about 68,000 located in Yolo County. The state capital is 20 minutes away, and world-class destinations such as the San Francisco Bay Area, Lake Tahoe and the Napa Valley are within a two-hour drive.

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