The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

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  Enters and updates provider data by reviewing and researching assigned incidents.
• Performs member moves in collaboration with Provider and Customer Service.
• Resolves routine system issues through incident process.
• Verifies accuracy of data on a daily basis; corrects errors as required.
• Assists with system testing, including but not limited to recommending and completing test scenarios and documenting test results.
• Collaborates with DBA to complete backend loads of data by notifying DBA of requirement and verifying results.
• Develops and maintains required documents and reports, including but not limited to desk level procedures.
• Participates in QUsers subgroups by representing HPSJ’s business interests.

Required

• Basic subject matter knowledge in at least two health plan functional areas.
• Basic knowledge of the features, functions and configuration of QNXT or similar system for at least three modules.
• Basic knowledge of and ability to plan, organize and execute basic configuration testing processes.
• Basic knowledge of general medical benefits and exclusions.
• Basic knowledge of the flow of data and information through a health plan.
• Produces work that is accurate and complete.
• Produces the appropriate amount of work.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
• Demonstrates a commitment to HPSJ’s strategy, vision, mission and values.
• Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Strong oral and written communication skills, with the ability to communicate professionally, effectively explain complex information, and document according to standards.
• Strong listening skills, with the ability to accurately receive and understand messages.
• Basic analytical skills, including the ability to perform routine analysis, using identified data, information and/or issues, and provide recommendations.
• Ability to work independently and as part of a team.
• Intermediate skills in Excel, Word, PowerPoint, Outlook, Visio and Windows.
• Ability to speak and be understood in English.
• Ability to treat confidential information with appropriate discretion.

Preferred

• Knowledge of provider and/or facility contract and payment structures, and reimbursement practices, including capitation.
• Knowledge of procedure coding and medical terminology.
• Knowledge of Medi-Cal, Medicaid and/or Medicare programs.

Required

• High school diploma or general education degree; and
• At least one year in provider services, customer service or claims;
• Experience using at least three QNXT modules or similar system; or
• Equivalent combination of education and experience.

Preferred

• Competitive salary
• Robust and affordable health/dental/vision with choices in providers
• Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D Insurance
• Employer-Paid Disability Insurance
• Employer-Paid Life Assistance Program
• Health Advocacy
• Supplemental medical, legal, identity theft protection
• Access to exclusive discount mall
• Education and training reimbursement in addition to employer-paid elective learning courses.
• A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
• A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
• Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.