**Description**



Adjudicates claims submitted by outside purchased services for PMC's enrolled capitated population and communicates those actions. Adjusts complex claims for advanced processing needs. Responds to Customer Service Requests and resolves problem claim situations.



Providence caregivers are not simply valued – they’re invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.



**Required Qualifications:**



+ H.S. Diploma or GED Or

+ Equivalent experience in Health Care Business Administration.

+ 2 years In Managed Care operations.

+ 1 year Claims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.

+ Experie...