Hiring: Claims Resolution Coordinator Company: Partnership HealthPlan of California Location: Shasta County, CA Job Posted Time: 2026-09-03 07:38:56 Target Skills & Keywords : Compliance, Elasticsearch About the job Experience: •Minimum 1 year of experience in claims examining or customer service within healthcare, insurance, finance, or managed care environment; or equivalent combination of relevant experience and education. Required Skills: •Answer s customer service lines as necessary and r espond s to provider inquiries either by phone, email , or in person rega rding claims related questions. •Review s , research es , and work s with various departments to resolve complex provider inqui ries, appeals, and grievances. •Act s as a resource and provide s support to customer service staff, as well as Provider Relations staff for complex Provider questions regarding claims and payments. •Coordinate s with Claims, Member Services, Health Services departments, the development, maintenance, and training of ongoi ng educational materials and tips for inclusion on the PHC website. I ncorporate s educational materials into the PR Manual and update on a quarterly basis. •Process es CIF's and adjustments as needed. •Write s and run s reports in Business Objects to obtain need ed claim data. •Track s and analyze s provider trends with denials and CIF's to provide support to providers with an opportunity to improve. Distribute s provider scorecards . •Track s complaints, appeals, and grievances by program. Report s activities on a quarterly basis to IQI, PHC Compliance Coordinator , and Claims Director. Qualifications: •Special Skills, Licenses and 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!