Job Details

Update claim information based on research and communication from provider, Health Plans, or state compliance offices Complete necessary adjustments to claims and ensure the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/ Medicare/ Medicaid guidelines, benefit plan documents) Communicate extensively with Heath Plans & Internal Business Partners regarding adjustments to resolve claims errors/issues, using clear, simple language to ensure understanding Learn and leverage new systems and training resources to help apply claims processes/procedures Ensure claim turnaround times are met and work toward metric deliverables This is a challenging role with serious impact. Youll be providing a high level of support and subject matter expertise within a fast paced, intense and high-volume claims operation where accuracy and quality are essential. Multitasking in...Claims, Representative, Processing, Microsoft, Remote, Health, Technology, Healthcare