Job Abstract

The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non-contracted providers.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required Qualifications:

• 2 years of Claims pricing and processing experience in ambulatory, acute care hospital, HMO or IPA environment.
• Experience processing all types of medical claims outpatient/inpatient UB-04 and HCFA-1500 claims as well as others.

Preferred Qualification:

• Experienced in interpreting provider contract reimbursement terms.

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.