Hiring: Claims Customer Service Representative I Company: Partnership HealthPlan of California Location: Fairfield, CA Job Posted Time: 2026-09-10 07:38:56 About the job Experience: •Knowledge of CPT, HCPC procedure coding, and ICD-10 diagnostic coding. Knowledge of medical terminology preferred. Ability to access coding reference guides for accurate information. Typing speed 30 wpm and proficient use of 10-key calculator. Required Skills: •Responds to provider telephone inquiries, researches policy issues, and analyzes EOP's and claim history, recommends resolution to the issues, implements resolution once approved. •Researches and communicates outcome to providers of CIF's, claim tracers, and general claim correspondence within established time frames •Follows established Partnership policies and procedures, Partnership claims operating instruction memorandums, EDS provider manual guidelines, and Title 22 regulations when resolving claims and claim issues. •Participates in provider meetings to resolve claim issues. •Recognizes and gives feedback to management on procedure changes that would result in more efficient operations. •Records daily production statistics and related activities on appropriate reports; turns all logs and reports in to Claims Customer Service Supervisor. •Meets established production and call performance metrics as determined. •Participates in special projects and assignments as required. Qualifications: •High school diploma or equivalent; one (1) year of prior claims processing experience in an automated claim environment preferred; or equivalent combination of education and experience. •Special Skills, Licenses and •Excellent written and oral communication skills. Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy. Good organizational skills. Ability to accurately complete tasks within established time frames. Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!