Providence Health & Services Risk Management Claims Representative, PSJH in California
Providence St Joseph Health is calling a Risk Management Claims Representative, PSJH based out of our location in Spokane, WA. This role is remote and can site in the footprint of Providence in AK, OR, WA, CA, TX, or MT.
We are seeking a Risk Management Claims Representative PSJH who will be responsible for claims management and administrative support to the Regional Claims Managers and other claims team members. Primary duties include processing invoices; administrative support in assigned insurance claims areas; opening and maintaining electronic claims files; entering claims and payment data; communicating with external counsel, experts and facility staff; providing back-up as needed for other Risk, Claims & Insurance position; and providing reports and other information from the claims database.
In this position you will:
Initiate and maintain electronic files in the STARS Claims Management system related to each claim assigned. Maintain expense and payment detail according to department standards and guidelines. Access information from the STARS data base and prepare standard and ad hoc reports as needed.
Compose correspondence; organize mail and messages; and confer with internal and external business partners to exchange information regarding claims investigation and management activities.
Support the Regional Claims Manager in other activities related to the management of claims and lawsuits. Collect data to prepare reports, prepare, and maintain spreadsheets and presentation graphics as requested.
Maintain calendars for case events, appointments, trials and other deadlines. Schedule meetings and make travel arrangements.
Prepare medical authorization forms and request medical records and other documents from System facilities and other entities including appropriate follow up and updated requests. Request, maintain and distribute medical records in compliance with HIPAA, related regulations and state law.
Communicate with outside counsel, witnesses, and others. Greet visitors, arrange conference calls or in house meetings. Answer inquiries or make referrals to the appropriate individual.
Coordinate receipt of various legal notices and prioritize delivery of urgent notices to contact lists and confirm receipt.
Develop plans and work processes needed for completion of assigned tasks, prioritize work load, coordinate and implement projects in assigned areas.
Coordinate and perform electronic and manual processing activities including expense reports and claims related bills. This includes resolving payment questions with accounts payable or with external business associates.
Maintain case lists, claims diary, reminder files, and task lists on behalf of Claims Managers.
Coordinate with staff in distribution, records and other support services as needed. Maintain department-related filing system.
Required qualifications for this position include:
Associate's Degree in related field.
4 years relevant administrative assistant experience in an insurance company, law firm or similar setting or satisfactory completion of the items listed in the Job Specific Knowledge, Skills and Abilities section.
About the department you will serve.
Providence Shared Services provides a variety of functional and system support services for our Providence family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Quality/Risk/Safety (Non-Clinical)
Other Location(s): Montana, Nevada, California, Oregon, Washington, Texas, Alaska
Req ID: 322175