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Spectrum Health Temporary Claims Coordinator Priority Health in Grand Rapids, Michigan

CURRENT SPECTRUM HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Spectrum Health team members only.

Job Description

Job Summary

This position is production and quality based. The Coord will be competent in all functions of a Claim Coord, Assoc and Coord, Claims in addition to more complex claim and issue resolution. Examples of complex claims may include: secondary claim coordination; customer inquiries; claims adjustments.

Essential Functions

  • Process claims through on-line adjudication. May include HMO, ASO, POS, GP, and dental claims. Processing to include complex claims. Complex claims may include: secondary claim coordination, customer inquiries, claim adjustments.

  • Utilize facets inquiry tracking system to initiate and resolve claim related issues.

  • Detailed knowledge of operational/technical functions and software.

Qualifications

  • Required High School Diploma or equivalent

  • 2 years of relevant experience in related field Required

  • Working knowledge of claim payment process and interdependence with other departments. Preferred

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

PH - Claims - Governmental

Employment Type

Full time

Shift

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected

category. See more here (https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf) .

Who We Are

Spectrum Health is a nationally recognized not-for-profit health system, offering a full continuum of health services through our health plan, medical group and hospital group. As an integrated health system, we are able to work together across all facilities, employees and providers to create exceptional, consumer-focused interactions.

Spectrum Health is redefining what it takes to improve the health of our communities and introducing new and innovative ways for consumers to access high-quality, low-cost care so that they can connect with us for a lifetime of health.

We strive to provide one Spectrum Health experience: a consistent, high-quality, seamless health journey for consumers; no matter where, when or how they interact with us. The result is better health outcomes for the thousands of individuals, families and communities we serve.

We are the region’s largest employer, with corporate offices located in Grand Rapids, Michigan. Spectrum Health Hospital Group and Spectrum Health Medical Group are consistently recognized for the exceptional care they provide. Priority Health is among the largest health system-sponsored health plans in the U.S. and offers extensive experience serving large and small employer groups, individuals, Medicare Advantage, Healthy Michigan Plan and Medicaid populations.

Since 2010, Spectrum Health has been listed five times among the 15 Top Health Systems in the U.S. by Truven Analytics™. Click here (https://www.spectrumhealth.org/about-us/quality-safety-and-patient-experience/awards) to see a complete list of our safety, quality and patient experience awards.

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