Claims Response Specialist
Lovelace Health Plan - Albuquerque, NM

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Lovelace Health Plan is part of the family of companies that make Lovelace Health System one of the leaders across New Mexico's health care system. When you work with Lovelace Health Plan, our goal is to improve quality care, and affordable accessible health care for New Mexicans. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and integrated Healthcare System. Lovelace Health Plan has an immediate opening for a Claims Response Specialist.

Responsible for supporting the Health Plan and maintaining positive working relationships with providers, key stakeholders, business units, departments and/or divisions within the assigned area. Provides consistent and accurate resolution to providers’ inquiries to include in depth claims research and coordination with the BPO on claim adjustments.

Minimum: High School Diploma or GED equivalent

Strong computer and phone skills: word, excel, access. Excellent oral and written communication skills to communicate with professionals and outside agencies; Product or multiple lines of business knowledge required (including but not limited to HMO, PPO, POS, Medicare, Medicaid); Ability to translate policy and procedural information; Ability to work through multiple concurrent tasks and handle stressful situations

• Minimum two years of work experience in claims review, claims processing and/or appeals in the Health Care Industry required.

Lovelace Health System consists of Lovelace Medical Center, Lovelace Rehabilitation Hospital, Lovelace Women’s Hospital, Lovelace Westside Hospital, Heart Hospital of New Mexico at Lovelace Medical Center, the Lovelace Health Plan offering health insurance to 240,000 New Mexicans with access to a wide range of health care providers and specialists across New Mexico, S.E.D. Medical Laboratories, and 11 retail pharmacy locations in Albuquerque, Rio Rancho and Santa Fe.

Lovelace Health System - 2 years ago - save job
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