Provider Claims Representative (8a-5p) - Houston, TX

Position: Provider Claims Representative (8a-5p) - Houston, TX

Job ID: 142117

Location: US-TX-Houston


Talent Area: Clerical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

Texas Children’s Health Plan   Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 13,000 dedicated team members, visit for career opportunities. You can also learn more about our amazing culture at


We are searching for a Provider Claims Representative – someone who works well in a fast-paced hospital setting. In this position, you’ll handle customer concerns and issues which require a high degree of appropriate knowledge, creativity, research, and communications with external resources. Your main aim is to lessen the probability of customer complaints by managing problem situations referred by resolving issues as they are presented. 


Think you’ve got what it takes?

Responsibilities :

Job Duties & Responsibilities


  • Supports the call and service centers’ day to day operations
  • Completes document intake for Provider Relations and Care Coordination
  • Participates in quality initiatives and performance measurements


Skills & Requirements


  • Bachelor’s degree in business administration, health education or related field
  • In lieu of a Bachelor’s degree, you may apply with a combination of a high school diploma or GED and a minimum four (4) years of experience in health care administration, managed care, or office administration
  • Minimum of two (2) years as a Member Service Representative or Claims Examiner is preferred
  • General knowledge of the health plan operations, claim systems and claim processing, and health care benefits
  • Ability to work well with the public and adopt a customer perspective
  • Work well in a team environment
  • Effective interpersonal skills
  • Strong verbal communication skills, good listening skills, and problem identification and problem solving skills
  • Ability to multitask and display leadership skills

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