Claims Quality Specialist

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

One Community. One Mission. One California 

The Claims Quality Specialist is responsible for ensuring the accuracy and quality of claims processing within a managed care service organization. This role involves auditing claims, identifying errors, and implementing corrective actions to improve overall claims accuracy and efficiency. The Claims Quality Specialist will work closely with the Claims Research colleague and other team members to enhance claims processes and ensure compliance with regulatory standards.

Minimum Qualifications:

• Minimum of 5 years of experience in claims processing, quality assurance, or a related role within a managed care or healthcare environment.
• Strong knowledge of healthcare claims processing, coding (ICD-10, CPT, HCPCS), and billing practices
• Proficiency in using a managed care and/or claims processing platform.
• High School Diploma or equivalent required

Preferred Qualifications:

• Experience with data analytics tools and software such as SQL, SAS
• Previous experience working directly with healthcare providers or within a provider network setting
• Bachelor’s Degree - Bachelor’s degree in Business, Healthcare Administration, or a related field