Claims Specialist

Providence

Claims Specialist adjudicating claims submitted for PMC's capitated population and resolving complex claim situations. Joining Pacific Medical Centers with a focus on patient care and support.

Posted 5/22/2026full-timeSeattle • Washington • 🇺🇸 United StatesMid-LevelSenior💰 $22 - $34 per hourWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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.
Experience with areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health and Encounters).
Information systems supporting the administration of managed care products.

Benefits

Comp & perks

Health care benefits (medical, dental, vision)
Retirement 401(k) Savings Plan with employer matching
Life insurance
Disability insurance
Time off benefits (paid parental leave, vacations, holidays, health issues)
Voluntary benefits
Well-being resources

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

claims processingadjustmentscomplex claims adjustmentspecialty claim processingCOBPoint of ServiceHome HealthEncounters

Soft Skills

communicationproblem-solving

Certifications

H.S. DiplomaGED