Certified Call Center Claims Processor I at AllCare Health with the Claims Department in Grants Pass, Oregon

We Are Seeking Qualified Candidates to Join Our Team!

AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.

Summary of the Position

The Certified Claims Call Center Processor I serves as a primary point of contact for provider offices and their authorized representatives, responding to inbound calls and electronic inquiries regarding professional and facility claims processing and adjudication.

This role combines customer service and certified claims processing responsibilities by independently resolving provider inquiries, researching claim issues, and adjudicating professional claims in accordance with company policy, contract language, coding guidelines, and applicable regulatory requirements.

The position is responsible for delivering timely, accurate, and professional claim resolutions while supporting positive provider relationships and maintaining departmental quality and production standards.

Essential Duties

• Provider Communication & Support – Responds promptly and professionally to inbound provider calls, emails, and other inquiries regarding claim status, adjudication outcomes, benefits, pricing, coding, and payment determinations.
• Claims Review & Resolution – Independently researches and resolves professional claim issues by reviewing claim history, coding, benefits, pricing logic, contract language, and applicable system edits to determine appropriate outcomes.
• Claims Adjudication - Accurately adjudicates professional claims by applying CPT, HCPCS, ICD-10 coding guidelines, reimbursement methodologies, benefit plans, and regulatory requirements.
• Documentation & Record Maintenance – Maintains accurate and detailed documentation of provider interactions, claim research, resolutions, and claim adjustments within the core claims system and applicable tracking tools.
• Provider Education & Support – Explains claim outcomes, billing requirements, and processing guidelines to providers and their representatives while promoting positive provider relationships and understanding.

Job Duties

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Computer Skills

Company Overview

AllCare Health Website: https://www.allcarehealth.com.

AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp® status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/about-b-corps)

AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.

The AllCare Health family of businesses is guided by our corporate principles:

Purpose | Working together with our communities to improve the health and well-being of everyone.

Values | Trust, Innovation, Relationships, and Voice.

Vision | Thriving, Inclusive, and Equitable communities.

Brand Promise | Changing Healthcare to Work for You.

AllCare Health is dedicated to building a diverse and authentic workplace centered in belonging and serving our growing community. If you are excited about this open position but your experience does not align perfectly with every qualification in this post, we encourage you to apply anyway or reach out to our human resources department. You may just be the right candidate for this role or others.

If you need accommodations, help in the application process, or wish to receive this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.