Partnership HealthPlan of California

To research and resolve complex claims issues which cr oss interdepartmental lines and communicate the outcome to providers and affected PHC managers.. Coordinate s with Claims, Member Services, Health Services departments, the development, maintenance, and training of ongoi ng educational materials and tips for inclusion on the PHC website.. Report s activities on a quarterly basis to IQI, PHC Compliance Coordinator , and Claims Director.. Minimum four (4) years claims examining experience; three (3) years PHC CSR III or above claims experience and completion of PHC claims training; or equivalent combination of education and experience; College course work in business or related field preferred.. Use good judgment in making decisions within sco pe of authority and handle sensitive issues with tact and diplomacy.

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