Provider Services - Claims Administrator

Provider Services - Claims Administrator

Crystal Stairs, Inc. is committed to building and sustaining a diverse workforce and culture. As part of this commitment, Crystal Stairs does not and shall not discriminate on the basis of race, color, religion, gender, gender expression, age, national origin, disability, marital status, sexual orientation, or military status, in any of activities or operations. Provider Services - Claims Administrator 100% Onsite - Los Angeles CA 90056

What We're Looking For : We are seeking a qualified candidate for the Claims Administrator position. The Claims Administrator is responsible for managing all payment-related matters for child care service providers, both licensed and license-exempt participating in Child Care Subsidy Programs. This role involves ensuring accurate and timely claim processing while providing high-quality customer service to child care providers and internal stakeholders. The Claims Administrator must maintain the utmost levels of confidentiality when handling sensitive information related to families and providers.

Responsibilities

• Evaluate and review documentation for provider claims to ensure compliance with contractual requirements, applicable regulations, and agency policies and procedures.
• Identify, track, and report processing discrepancies to appropriate staff, and resolve all issues by processing payment adjustments and / or authorizations within designated timeframes.
• Assist in the preparation and completion of monthly reports to support agency compliance with timely and accurate provider payments.
• Research and resolve provider payment inquiries, ensuring timely and thorough follow-up and clear communication of outcomes.
• Review claims for accuracy, ensuring all required documentation is complete, appropriate, and properly entered into the system prior to each scheduled provider payment export.
• Review and maintain a documented record of all claim returns, payment adjustments, provider income verification requests, and stop payment requests, including actions taken and current status.
• Collaborate with management to identify and implement process improvements and assist in training staff to enhance efficiency and productivity.
• Participate in workgroups, committees, and ad hoc teams as assigned, contributing to collaborative efforts and agency initiatives.
• Perform other related duties as assigned by the Supervisor or Manager.

Experience, Knowledge, Skills and Abilities You Should Possess

Total Package of Benefits

Crystal Stairs, Inc. is committed to building and sustaining a diverse workforce and culture. As part of this commitment, Crystal Stairs, Inc. provides equal opportunity in all of our employment practices, including selection, hiring, promotion, transfer, and compensation, to all qualified applicants and employees without regard to race, color, medical condition as defined by state law, ancestry, religion, sex, national origin, age, marital status, sexual orientation, gender, ethnic group identification, mental or physical disability, pregnancy, childbirth and related medical conditions, or any other legally protected status. Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.