Monday, June 18, 2018

Health Care Claims Examiner I

Recruitment #17-1461-01


THIS IS A NEW ASSEMBLED EXAMINATION.  The eligible list resulting from this examination will cancel any existing list and may last approximately one year, but can be extended. Applications must be in the possession of the Human Resource Services Department by 5:00 p.m. on the Last Day for Filing.  Applications will only be accepted on-line.

Supplemental Questionnaire:  A properly completed Supplemental Questionnaire must be submitted with each application.  Applications and Supplemental Questionnaires must be in the possession of the Human Resource Services Department by 5:00 p.m. on the Last Day for Filing. Postmarks are not accepted.  Failure to submit the Supplemental Questionnaire will result in disqualification





Alameda County, located on the east side of San Francisco Bay, is California's seventh-largest county.  The County employs 9,080 full-time employees and operates on an annual budget of $2.39 billion.  Oakland, the County seat, is California's eighth largest city.  One and a half million people call Alameda County home and live in a variety of incorporated cities, unincorporated communities and rural areas.  As a major urban county, Alameda provides a full range of services to its citizens.  The County is a blend of culturally and ethnically diverse communities, and its mixture of cosmopolitan and suburban areas provides the perfect environment for families and their active lifestyles.  The County offers extensive cultural resources, countless recreational opportunities and an array of fine public and private colleges and universities. 



Alameda County's Health Services Program is administered by the Health Care Services Agency and includes the following program areas: Behavioral Health Care, Public Health, Environmental Health, and Agency Administration/Indigent Health. The ultimate mission of the Health Care Services Agency is to provide fully integrated health care services through a comprehensive network of public and private partnerships that ensure optimal health and well-being and respect the diversity of all residents. Health Care Services Agency currently has multiple career opportunities for experienced professionals to become part of a service delivery team dedicated to the optimal health and well-being of Alameda County residents. 



It is the mission of Behavioral Health Care Services to maximize the recovery, resilience and wellness of all eligible Alameda County residents who are developing or experiencing serious mental health, alcohol, or drug concerns. We envision communities where people realize their potential, and where stigma and discrimination against those with mental health, alcohol and/or drug issues are a thing of the past.

Only through exemplifying the following Alameda County Behavioral Health Care Services values will we be successful:


Access - where every door is the right door for welcoming people with complex needs;

Consumer and Family Empowerment - through shared decisionmaking best practices, that clinically produce effective outcomes;

Best Practices - business excellence that uses public resources costeffectively;

Health and Wellness - by integrating emotional, spiritual and physical health care;

Culturally Responsive - appropriate services built on the strengths and life experiences of culturally diverse consumers and their families;

Social Inclusion - utilizing advocacy and education to eliminate stigma, discrimination, isolation, and

misunderstanding of persons with mental illness and substance abuse.

For more information about the department of Behavioral Health Care Services, please visit



Under general supervision, to review, evaluate, edit and process claims for payment for Behavioral Health Care Services Providers; to verify eligibility for a variety of insurance plans/programs, determine the primary payor and establish payment authorization based on program requirements; and to perform other related duties as assigned.



These positions are located in the Behavioral Health Care Services, Claims Processing Center and report to the Health Care Claims Manager. Health Care Claims Examiners process a variety of provider claims for services rendered to beneficiaries of Alameda County Medi-Cal program, CalWORKS program, Child and Family Services program, Healthy Families program and Indigent Children program, and other benefit plans for Psychological services.

Health Care Claims Examiner I is the entry-level class in this flexibly staffed series. This class is the training level, and incumbents are expected to gain experience and demonstrate proficiency which qualifies them to promote to the higher level after six months of full-time experience. Appointment at this level will not be extended beyond six months.



In addition to the minimum qualifications and knowledge and skills listed below, ideal candidates will possess and have successfully demonstrated, and exemplify the following critical attributes:

  • A quality oriented individual who accomplishes tasks by being attentive to details and who understands the importance of checking processes and tasks over time in order to minimize consequence of errors.  
  • Someone who is analytical, resourceful, and skilled at gathering and synthesizing information from a variety of stakeholders and sources in an objective, unbiased manner to reach a conclusion.
  • A competent decision maker capable of taking action consistent with all available facts, constraints, and probable consequences in a fast paced environment by identifying and understanding issues, problems, and opportunities, and comparing data from different sources to draw conclusions.
  • An effective communicator who conveys information and in a manner that meets audience needs; someone able to develop and maintain effective relationships with others and who relates well to people of diverse cultures, interpersonal styles, abilities, motivations, or backgrounds even in times of conflict.
  • Someone who is agile and capable of smoothly and quickly adapting to change, is open to different perspectives, and who adjusts effectively to work within new work structures, processes, requirements, or cultures.
  • An experienced health care claims professional who keeps up with terminology and current developments and trends in health care claims processing and who has achieved sufficient technical skill and/or knowledge in order to process claim payments and verify eligibility for a variety of insurance plans/programs.
  • Someone who is well organized and able to plan and coordinate work activities, successfully managing several tasks at once to ensure that work is completed efficiently.

For a detailed listing of the duties and essential competency requirements for this position, please see the Health Care Claims Examiner I job specification.



Experience: The equivalent of six months full-time experience in a class equivalent to or higher than Specialist Clerk I performing independent interpretation, problem-solving, research and complex clerical duties in the Alameda County classified service. (Non-classified includes District Attorney’s Office, Hospital Authority, and the Consolidated Courts.

The equivalent of one year of full-time experience in reviewing, evaluating, editing and processing claims for payment, and determining eligibility for a variety of insurance plans/programs.

NOTE: The Civil Service Commission may modify the Minimum Qualifications in the announcement of the examination.


NOTE: The level and scope of the following knowledge and abilities are related to duties listed under the "Examples of Duties" section of this specification.

The most suitably qualified candidates will possess the following competencies:

Knowledge of:

• Parameters of the provider’s contract obligations.
• Current policies and requirements for an array of administered insurance plans (e.g. Medi-Cal, Healthy Families, and Children’s Indigent Plan) and other regulations as they relate to insurance benefit plan/program eligibility.
• Basic policies and operations of health care insurance plans.
• Federal, State and local rules and regulations as they relate to claims processing.
• Modern office practices and procedures.
• Business mathematical computation.
• Computer application related to the work.

Ability to:

• Comprehend, interpret and follow complex instructions related to various insurance benefit programs and plans.
• Verify appropriate eligibility for a variety of insurance plans/programs.
• Exercise interpersonal sensitivity to establish and maintain effective working relationships with staff, clients, other agencies, and the public.
• Exercise independent judgment.
• Analyze, evaluate and draw logical conclusions.
• Maintain confidentiality.
• Plan and organize work.
• Prioritize work and coordinate multiple activities to meet critical deadlines.
• Perform accurate mathematical calculations.
• Communicate effectively orally and in writing.
• Understand and follow complex oral and written instructions.
• Work independently and adapt to change.
• Input accurate data into various computer systems and software programs.


THE EXAMINATION WILL CONSIST OF THE FOLLOWING STEPS:  1) A review of candidates' applications to verify possession of minimum requirements. Those candidates who possess the minimum requirements for the class will move on to the next step in the examination process; 2) A review of candidates’ Supplemental Questionnaires to select the best qualified applicants to continue in the process; 3) An oral examination which will be weighted as 100% of the candidate's final examination score. The oral examination may contain situational exercises.



***We reserve the right to make changes to the announced examination components***


Alameda County utilizes a Civil Service Selection System founded on merit.  Such a system is competitive and based on broad recruitment efforts and equal opportunity for qualified applicants to test in an examination process designed to determine the qualifications, fitness and ability of competitors to perform duties of the vacant position.  Many of our recruitments are targeted and specific to the needs of a current vacant position, in which case, the eligible list may be exclusively used for that current vacant position.  Other recruitments many be more broadly used for both current and future vacancies, or for other alternate jobs with comparable scopes of work.


To learn more about our recruitment and selection process, please visit the “What You Need to Know” section of our website,

Selection Plan

Applicants will be informed via email with reasonable notice in advance of any examination process which will require their attendance.  The following dates are tentative and subject to change based on the needs of the Agency: 




Deadline for Filing

5:00pm, Friday, October 13, 2017

Review of Minimum Qualification

October 20, 2017

Supplemental Questionnaire Review for Best Qualified

November 6-9, 2017

Oral Interview Exam**

November 28-29, 2017

**The combined oral examination/hiring interview, in addition to establishing an eligibility list, may serve as the final selection interview for vacancies in this classification.




Alameda County and the Human Resource Services Department will make reasonable efforts in the examination and/or selection process to accommodate qualified individuals with disabilities and/or medical conditions in accordance/compliance with the State Fair Employment and Housing Act (FEHA), Federal Americans with Disabilities Act (ADA) Alameda County’s Reasonable Accommodation Policy and applicable statues.  To request an accommodation due to a disability/medical condition during this or other phases of the examination/selection process, please contact the assigned Human Resources Representative listed on the job announcement before the last date of filing. Alameda County requires applicants to provide supporting documentation to substantiate a request for reasonable accommodation. In order to qualify for a reasonable accommodation, applicants must have a disability/medical condition pursuant to the ADA, FEHA and applicable statutes.


For more information regarding our Reasonable Accommodation procedures, please visit our website,


Alameda County offers a comprehensive and competitive benefits package that affords wide-ranging health care options to meet the different needs of a diverse workforce and their families. We also sponsor many different employee discount, fitness and health screening programs focused on overall well being.  These benefits include but are not limited to*:

For your Health & Welfare Benefits

  • Medical – HMO & PPO Insurance
  • Dental – PPO & DHMO Insurance  
  • Vision
  • Basic Life Insurance 
  • Supplemental Life Insurance (with optional dependent coverage) 
  • County Allowance
  • Health Flexible Spending Account
  • Dependent Care Flexible Spending Account
  • Accident, Critical Illness & Hospital Indemnity
  • Employee Assistance Program

For your Financial Future

  • Short-term Disability Insurance
  • Long-Term Disability Insurance
  • Retirement Plan – (Defined Benefit Pension Plan)
  • Deferred Compensation Plan

For your Work/Life Balance

  • 11 paid holidays
  • Vacation and sick leave accrual
  • Vacation purchase program
  • Management Paid Leave**
  • Group Auto/Home
  • Commuter Benefits Program
  • Guaranteed Ride Home
  • Employee Wellness Program (e.g. At Work Fitness, Incentive Based Programs, Gym Membership Discounts)
  • Employee Discount Program (e.g. theme parks, cell phone, etc.)
  • Child Care Resources
  • 1st United Services Credit Union 

*Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement.  This provides a brief summary of the benefits offered and can be subject to change.

** Non-exempt management employees are entitled to up to three days of management paid leave. Exempt management employees are entitled to up to seven days of management paid leave.


All notices related to County recruitments for which you have applied will be sent/delivered via email. Please add and as accepted addresses to any email blocking or spam filtering program you may use. If you do not do this, your email blocking or spam filtering program may block receipt of the notices regarding your application for recruitments. You are also strongly advised to regularly log into your County of Alameda online application account to check for notices that may have been sent to you. All email notices that will be sent to you will also be kept in your personal online application account. You will be able to view all of your notices in your online application account by clicking on the "My applications" button on the Current Job Openings page.

Please take the steps recommended above to insure you do not miss any notices about a recruitment for which you have applied. The County of Alameda is not responsible for notices that are not read, received or accessed by any applicant for a County recruitment.

NOTE: All notices are generated through an automated email notification system. Replies to the email box are routed to an unmonitored mailbox. All notices are generated through an automated email notification system. If you have questions please go to our website at You may also contact the Human Resources Analyst listed on the job announcement for the recruitment for which you have applied.

Nicole Lewis-Bolton, Human Resources Analyst II

Human Resource Services, County of Alameda

(510) 272-6468 •